Reply #197: Then you'll have to settle for these findings, for the moment:

[Judi Lynn]

The Cuban Paradox

Perhaps best known for vintage cars, cigars, and communists, Cuba is also distinguished by something far more enticing to the students and staff of the Harvard School of Public Health--its health care system. The Cuban government assumes full fiscal and administrative responsibility for the health care needs of all its citizens, providing free preventive, curative, and rehabilitation services. This National Health System, as it's called, is an international success story and, for the last three years, a small group from the School has made its way down to this sunny island nation to learn more about what makes it tick. "It's good for people to see another system," says Richard Cash, senior lecturer in the School's Department of Population and International Health. "Seeing for yourself is far more important and to see what Cuba does with limited resources and to contrast it with our system and other systems is valuable. Everyone that has gone to Cuba has come away clearly educated by the process."

This March, Cash was joined in this educational experience by 12 MPH students. Roberta Gianfortoni, director for professional education at the School, has organized the trip since its inception and coordinated this year's excursion with Medical Education in Cooperation with Cuba (MEDICC), a non-profit organization that specializes in offering elective experiences in Cuba to US and Canadian students in the health and medical sciences. The School's contingent traveled under a special license granted to the MEDICC. Over an eight-day stay in the Cuban capital of Havana, the group visited institutions such as the Ministry of Public Health, maternity hospitals, schools of medicine and public health, AIDS sanatoria, and community health clinics. "The objective is to look at an alternative system," says Gianfortoni. "It's an interesting model to study. Our students are going to go to both developed and underdeveloped countries so it's interesting to consider how Cuba's concepts and methods can translate to other parts of the world."

Socio-economic development is typically measured by health indicators such as infant mortality and life expectancy at birth. However, in Cuba, a nation beset by severely limited resources and political tensions both internal and external, these health markers are essentially the same as those in the United States and other parts of the industrialized world. Cuba also boasts the highest rate of public health service in Latin America and has one of the highest physician-to-population ratios in the world. Alone remarkable for a developing country, these feats are even more extraordinary considering the context of a US embargo that's been in effect since 1961. Because its access to traditional sources of financing is seriously hindered by the sanctions, which until rec- ently included all food and medicine, Cuba has received little foreign and humanitarian aid to maintain the vitality of its national programs. And herein lies the paradox of Cuba's health care system: because Cuba has so few resources, prevention has become the only affordable means of keeping its population healthy.

"I find Cuba's system to be very inspiring because it is so public health focused," says Tracy Rabin, who has made the Cuba trip twice. She traveled the first time as a student in the Department of Immunology and Infectious Diseases; this year she participated as a research associate and program manager for the Program on Ethical Issues in International Health Research in the Department of Population and International Health. Her impressions are not an illusion: despite the economic difficulties of recent years, spending on public health in Cuba has increased steadily, which reflects the political will to maintain successes achieved in this area. An August 1960 law established the Ministry of Public Health as the highest authority responsible for health care. The same year, the Rural Social Medical Service was created, allowing Cuba to place doctors and nurses in the country's remotest areas to bring medical attention to inhabitants there.
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http://www.hsph.harvard.edu/review/review_summer_02/677cuba.html