What Senator Harkin and I Discovered About Cuba’s Healthcare System
Retiring Senator Tom Harkin and I have common interests. We share a passion for improving the quality of life for people with disabilities and we both support the ratification of the United Nations Convention on the Rights of Persons with Disabilities. We have both been to Cuba twice and we have both been criticized for our comments about Cuba’s healthcare system.
Neither Senator Harkin nor I said that Cuba has better healthcare than the US - what we said is we think Cuba’s healthcare “system” is impressive.
Senator Harkin and I praised the strengths of Cuba’s system, including a focus on preventative healthcare and training enough healthcare workers to serve every community. We are not alone in our praise. Salim Lamrani, in an October 2014 Huffington Post blog wrote: “During her recent visit to Havana in July of 2014, Margaret Chan, Director-General of the World Health Organization (WHO), impressed by the country's achievements in this field, praised the Cuban health care system.”
In October, the New York Times ran an article entitled “Cuba’s Impressive Role on Ebola” and noted that WHO is directing a team of Cuban doctors. Secretary of State John Kerry praised “the courage of any health care worker who is undertaking this challenge,” and made a brief acknowledgment of Cuba’s response.
In 2011, I received an invitation from the American Public Health Association (APHA) to visit Cuba under a special license to research its public health systems and support. While the purpose of the trip was broad in focus, it included visits with representatives from national ministries, the Latin American School of Medicine (ELAM), family doctors’ offices, polyclinics and general hospitals. I returned to Cuba in 2014, again on a special license to study its healthcare and its culture. In addition to medical facilities, I toured daycare centers, schools, elder care facilities and cultural centers. On each trip I was able to meet and interact with residents and hear some of their successes and struggles.
On the second trip, I listened to former Cuban diplomat Camilo Garcia Lopez-Trigo speak about improving conditions and I did notice improvement in Cuba in the three years between visits. Private enterprise and tourism are growing and repairs are being made to crumbling buildings. Signs direct you to local paladares (privately-run restaurants), jazz clubs and shops.
On both trips I met with Dr. Jose Portilla, from the Cuban Health Ministry. He offered a brief history of Cuba’s healthcare system, pointing out that healthcare is a right under the Cuban constitution. He explained the foundation of their system is the family doctor’s clinic with a doctor and nurse for every 50 to 60 houses in a community. The next level is the community-based polyclinic, which serves 20 to 40 of the family doctor offices. General hospitals and teaching centers, which specialize in neurology, orthopedics, oncology, etc., are available for specialized care.
I saw the emphasis on prevention. In a country known for its rum and cigars, every doctor office and clinic has posters and educational materials on alcoholism, smoking, HIV/AIDS and other diseases. The healthcare workers say they know everyone in the community and that intervention is started as soon as a condition is apparent. Our guide confirmed this emphasis. She also noted that while there is poverty, there is no misery. She believes that everyone in Cuba gets enough to eat and everyone has access to healthcare.
While I toured some of the better facilities, my research and observations also revealed hospitals that needed repairs and pharmacies with too few drugs and supplies. Some of the health care professionals bemoaned the lack of access to the Internet. I also witnessed some of the challenges for people with disabilities posed by navigating an aging infrastructure. I questioned Dr. Portilla about this and he said that advances made in Cuban health care began to deteriorate during the Special Period - an extended period of economic crisis that began in 1991 after the dissolution of the Soviet Union. He was careful not to start political discussions, but he alluded to the U.S. embargo as being another reason for the lack of equipment and supplies.
Every year in the United States, millions of people die preventable deaths. As our country continues to debate the pros and cons of the Affordable Care Act, universal health coverage and access to care issues, policy makers may be well served to look to Cuba for a bit of inspiration when it comes to incorporating some of these fundamental public health building blocks into our own system. Theirs is a system that emphasizes the role of prevention and prenatal care, values the role of community-based services, and understands the important and integral role of the family in providing care. Imagine those principles coupled with our abundance of medical facilities and equipment.
Shelia Newman, President, New Editions Consulting, Inc. has over 25 years of experience in Federal government contracting. Read Shelia's bio.