Cuban Health Care: Costs, Approaches, Human Rights Considerations

Cuban health care system is largely recognized as one of the most efficient and effective ones in the world, both in popular media (van Gelder, 2007) and in academic literature (Dresang, Brebrick, Murray, Shallue, & Sullivan-Vedder, 2005). They produce quality of care and health outcomes typical of well-developed, industrialized countries at a fraction of the cost and within the economic system of a developing country (Dresang et al., 2005; Riley, 2007). Generally accepted reasons for this situation combine social, political, and economic factors, specifically Cuba's socialist system of distributing social services, its ability to incorporate multiple and varying methods in its health care in lieu of the U.S. influence due to the longstanding embargo, and its heavy reliance on prevention rather than treatment and recovery as the basic approach to care, representing a cost-saving measure.

Like many other Caribbean cultures, Cubans define health as the combination of physical and mental well being (van Gelder, 2007; Riley, 2007). Illness, therefore, is defined as the disruption of the balance between these two elements. Physical well being is emphasized as the more important one for maintaining this balance, especially among the younger generations: such mottos as "Healthy Spirit in a Healthy Body" are part of the Cuban Socialist ideological makeup (van Gelder, 2007; Dresang et al., 2005). To that extent, and to a considerable degree due to poor economic conditions in post-revolutionary Cuba, health care concentrates heavily on prevention rather than treatment and recovery.

Since the mid-1980s, Cuban health care system has been organized into a three-tiered hierarchy (Dresang et al., 2005; Sadun, 2005). At its foundation is the general practitioner, operating both through house calls and through the network of consultorios, or neighborhood clinics. General practitioner, along with the assigned nurses, is required by law to visit each member of his or her defined geographic area no less than twice a year. During these visits, aside from treating any existing condition, if any is present, the family physician administers vaccinations and distributes vitamins. Such a system of universal prevention has resulted in the lowest rates of child mortality, parasites, tuberculosis, malaria, and HIV/AIDS per capita in Latin America (van Gelder, 2007). The fact that child vaccination in Cuba is mandatory by law also contributes to the situation.

If the neighborhood's general practitioner thinks that patients require care beyond the scope he or she can provide, such a patient is referred to the second health care tier - the policlinico, or specialty clinic (Dresang et al., 2005; Sadun, 2005). The most challenging cases and patients requiring subspecialty care are referred to the third tier - hospitals (hospitals) and institutos (medical institutes). On average, consultorios handle over 80 percent of all care in the country (Dresang et al., 2005).

Cuba's authoritarian approach to her citizen's human rights also plays a role in checking the spread of highly infectious and incurable diseases. For example, the majority of individuals diagnosed with HIV/AIDS are forcibly isolated from the general population in specialty sanatoriums, despite the official lifting of such quarantine provisions in 1994 (Hansen & Groce, 2003).

"Folk" treatments in Cuba are based partially on the healing practice of espiritismo and Santeria (Wilson, 2006). Espiritismo is a belief that there is a spirit world that is surrounded by, but invisible to, the human world. Spirits can communicate with the human world and vice versa. Santoria is a combination system of belief based on the worship of Voodoo-like deities and Roman Catholic saints. Both practices are heavy on ritual and employ some herbal remedies. The bulk of what in the U.S. is called "alternative medicine" is administered in Cuba at policlinicos and is referred to as "natural and traditional medicine" (Dresang et al., 2005). In fact, an increasing number of Cuban medical professionals are being routinely trained in acupuncture, herbal medicine, massage therapy, and other such "complementary" approaches.

References
Dresang, L. T., Brebrick, L., Murray, D., Shallue, A., & Sullivan-Vedder, L. (2005). Family medicine in Cuba: Community-oriented primary care and complementary and alternative medicine. Journal of American Board of Family Practice, 18, 297-303.
Hansen, H., & Groce, N. (2003). Human immunodeficiency virus and quarantine in Cuba. Journal of American Medical Association, 290, 2875.
Riley, J. C. (2007). Low income, social growth, and good health: A history of twelve countries. Berkeley, CA: University of California Press.
Sadun, A. A. (2005). Ophthalmology in Cuba. Archives of Ophthalmology, 123, 1431-1432.
van Gelder, S. (2007). Why is Cuba exporting its health care miracle to the world's poor? Yes! (May 25). Online at: http://www.healthy.net/scr/news/asp?id=9167
Wilson, N. (2006). Complementary health practices. Health Tip Archive (October 1). Online at: http://ihouse.berkeley.edu/1/residents/healthtips.html