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Cuba and Their Health Care System

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Marco Naoe-Scandal

on 5 October 2013

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Transcript of Cuba and Their Health Care System

The Republic of Cuba
an archipelago in the Caribbean comprised of:

the main island of Cuba
the Isla de la Juventud
and several archipelagos

It's capital is Havana and it is also its largest city.
we'll look into these details about CUBA

(July 2013 est.)
Age Structure:
0-14 years: 16.6%
(male 944,254/female 892,766)
15-24 years: 13.9%
(male 787,368/female 748,315)
25-54 years: 46.9%
(male 2,611,371/female 2,578,471)
55-64 years: 10.3%
(male 544,465/female 595,856)
65 years and over: 12.3%
(male 611,086/female 747,934)
(2013 est.)

Total Dependency Ratio:
Total dependency ratio: 41.9 %
Youth dependency ratio: 23 %
Elderly dependency ratio: 18.9 %
Potential support ratio: 5.3 (2013)

Cuba is an archipelago
of islands located in
between the Atlantic Ocean
and Caribbean Sea.
East- North Atlantic Ocean
West – Gulf of Mexico
North – Straits of Florida
Southeast – Windward Passage
Southwest – Yucatan channel

total area of 109,884 km2 (42,426 square miles)
Carribean Sea at Sea Level
Pico Turquino
Despite the great recession in 2008, Cuban economy has been growing very modestly from 1.4% in 2009, 2.4% in 2010 and 2.8% in 2011 for an annual average up until 2012 of 2,4%.
The current performance of the Cuban economy stems from a socialist economic strategy centered on the creation of conditions for sustainable development in the medium term.
In pursuing this increase in growth rate, significant advances have been made:
1. Increased foreign exchange earnings through growth of more than 100% in the value of exported goods, while imports increased by only 54% between 2009 and 2012 resulting in a decrease in the current account balance in relation to GDP of -4.2% in 2008 to an estimated -0.6% in 2012.
2. Revising foreign financial commitments. By 2010, an agreement had been reached for the renegotiation of 2 billion dollars in foreign debt payments.
3. Growth in labor productivity
a. Gradual reduction in underemployment in the state sector,
b. Increasing activities in the cooperative, private and mixed sectors

Most of the industries in Cuba are controlled by the state. The most important mineral resource is nickel, of which Cuba has the world's second largest reserves (after Russia).Sherritt International of Canada operates a large nickel mining facility in Moa. Cuba is the world's fifth-largest producer of refined cobalt, a byproduct of nickel mining operations.
Oil exploration in 2005 by the US Geological Survey has revealed that the North Cuba Basin could produce approximately 4.6 billion barrels (730,000,000 m3) to 9.3 billion barrels (1.48×109 m3) of oil. In 2006, Cuba started to test-drill these locations for possible exploitation. Cuba holds 6.4% of the global market for nickel which constitutes about 25% of total Cuban exports.
• Beans
• Cassava
• Cobalt
• Chrome
• Coffee
• Copper
• Iron Ore
• Livestock
• Maize
• Nickel
• Oranges,
• Rice
• Sugar Cane
• Sweet Potatoes
• Tobacco
• Tropical Fruits.

Other MAJOR INDUSTRY includes the following:
• pharmaceuticals
• tobacco
• construction
• steel
• cement
• agricultural machinery
• sugar

Before 1959, the literacy rate of Cubans is at its nadir, having only a literacy rate of between 60 to 76 percent. With this, the Cuban Revolution established an ambitious program for one year trying to improve its status quo. As a result by the end of 1959,
According to the United Nations Educational Scientific and Cultural Organization (UNESCO), there are about one billion non-literate adults where two-thirds of it is comprised of women, approximating to about to 26 percent of the total population.
The Cuba on the other hand had a good track of record with respect to its literacy rate reaching at 99.8 percent of its population at the age of 15 years old and above able to read and write.
The Cuban Literacy campaign lead to national rising of literacy rate 96 percent.
• 2012: 3.6%
• 2011: 3.2%

Cuban unemployment is due to the passed reforms by the Cuban government to lay off workers from the government owned facilities or payrolls which affected over 1 million people from the public sector in the end of 2011. This event leads to the idea of self-employment by the people. Also the reform encouraged the selling of cars houses and lots by the people.
Some people in the
business sector gave up
their license so as to get
away from the high rents
and taxes that the
government are imposing.
Some of these businessmen considered street vending. They walk around the areas to sell their produce. Some took up farming as solution to the crisis. The reform paved ways to the high demands of jobs from the agricultural and construction industry but people find these jobs unattractive. Other alternative is to leave the country as to what 56,000 people did last year (2012)
Most economic studies of this phenomenon, and in particular those using the income or Poverty Line (PL) method, have revealed insufficient income to be the essential determinant of poverty and its sole, most important and widespread most form.
This view of poverty places emphasis on the inputs available to individuals or households to satisfy their material needs. Those individuals or households who do not have the monetary income to satisfy their minimum needs within the historically determined norms of a society are considered to be below the PL.
Insufficient income is primarily related to the decline in purchasing power of salaries and social security and assistance programs provisions. This occurs because nominal wages have not kept up with increases in the consumer price index. This particularly affects those whose main income comes from the State, such as traditional state sector employees who do not receive other benefits or perks and those receiving pensions and social assistance.
Lacking Medical
Shortage of Physicians
The refusal of the US to allow Cuba to import many medicines it needs slows down research progress and hurts the local health care system.
Particularly the specialized medical fields were harmed in the 1990s, when special equipment and medication was scarce and hard to come by. Although medical professionals were widely available, they could not make up for the dire condition of Cuba’s healthcare facilities. Many medications are also not available or can only be purchased at very high prices in the pharmacies that sell in foreign exchange.
With respect to healthcare, while the ratio of physicians per 10,000 inhabitants doubled between 1989 and 2010, about one-third of them have been sent for service abroad, the majority to Venezuela.
The government program to export medical services to other countries, while providing Cuba with a source of foreign exchange, has been carried to such an extent that there are now shortages of physicians and medical services at the local level
Obesity is increasingly affecting young adults and children. Cuba was among the four Latin American countries with the highest rates of obesity among 20–29-year olds in 1994, which of note was during the most difficult years of the Special Period. In examining contemporary childhood obesity, the Comprehensive Childhood Study of 2004-2005 found that 10.2% of children are overweight and 8.8% are obese. In 2005, the prevalence of excess weight in children <19 years of age in Havana was similar to that of 1972. However, there was a significant increase in high adiposity in children, many of whom had a normal BMI
Similar to other countries, tobacco use in Cuba is greater among men than among women. It is estimated that 40% of all men smoke tobacco every day, with a higher rate of 60% in middle age men.
Moreover, 25% of women and 32% of men age greater than 60 smoke tobacco, a figure much greater than other Caribbean and Latin American countries. Elderly Cubans smoke at higher rates than the rest of the population. A large study in Havana from 2011 estimated that 46.5% of elderly men and 21.5% of elderly women smoked tobacco.
Moreover, in the same study, an additional 31% of men and 15% of women were former smokers. The prevalence of tobacco use in Havana in this study was much greater than in Bridgetown, Barbados. In a 2003 case control study of patients with acute MI in Cuba, smoking was responsible for a third of the burden of acute myocardial infarction in Cuba.
Heart conditions and tumors were the major causes of death in Cuba in 2011, followed by cerebrovascular diseases, influenza, pneumonia and accidents, according to the National Statistics Office.
Infant Mortality Rate
total: 4.76 deaths/1,000 live births
country comparison to the world: 183
male: 5.12 deaths/1,000 live births
female: 4.39 deaths/1,000 live births (2013 est.)
Definition: This entry gives the number of deaths of infants under one year old in a given year per 1,000 live births in the same year; included is the total death rate, and deaths by sex, male and female. This rate is often used as an indicator of the level of health in a country.

Maternal Mortality Rate:
73 deaths/100,000 live births(2010)
Country comparison to the world: 86

Definition of Maternal mortality rate: The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.

The Constitution of 1992, which is guided by the ideas of José Martí and the political and social ideas of Marx, Engels and Lenin, describes the Communist Party of Cuba as the...
One of the world's four remaining

Education, Hospital and Medical Care
Social Security

"leading force of society and of the state"
Cuba's national legislature, the National Assembly of People's Power (Asamblea Nacional de Poder Popular), is the supreme organ of power
The country is governed under the constitution of 1976. The government is led by Fidel Castro, who was prime minister from 1959 until the post was abolished in 1976 and became president of the Council of State and president of the Council of Ministers in 1976. (The office of president is both head of state and head of government.)
History of Health Care System
Pre-hispanic Time
As was true of the other indigenous societies of the Americas, Cuban traditional medicine existed before the Spanish conquest. High-status traditional practitioners were called Bohiques.
19th Century
Spanish Occupation
"The most beautiful land on Earth" - Christopher Columbus
After colonization by the Spanish, Cuban medicine followed the Spanish tradition which was inherited from the Moors, Chinese medicine has also been practiced in Cuba. Its most famous practitioner was the 19th century doctor Cham Bom Biam or “El Medico Chino”.
the first surgical clinic was established in 1823.
Modern Western medicine has been practiced in Cuba by formally trained doctors since at least the beginning of the 19th century
The Hospital de San Felipe in Havana (in 1900), a healthcare educational facility built by the religious order San Juan de Dios in the mid-19th century
Cuba has had many world class doctors, including Carlos Finlay, whose mosquito-based theory of yellow fever transmission was given its final proof under the direction of Walter Reed, James Carroll, and Aristides Agramonte.
During the period of U.S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass and surgeon Jesse William Lazear.
By the 1950s,
most positive health indices in the Americas
one of the leaders in terms of life expectancy
number of doctors per thousand of the population ranked above Britain, France and Holland
The catch is...
Most of Cuba's doctors were based in the relatively prosperous cities and regional towns, and conditions in rural areas, notably Oriente, were significantly worse.
Only 8% of the rural population had access to healthcare.
The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.
increase in
infant mortality
Revolutionary and physician Che Guevara outlined his aims for the future of Cuban healthcare in an essay entitled On Revolutionary Medicine
"The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices."
These aims were hampered almost immediately by an exodus of almost half of Cuba’s physicians to the United States, leaving the country with only 3,000 doctors and 16 professors in the University of Havana’s medical college.
Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states...
has the
right to health protection and care.
The state guarantees this right by
providing free medical and hospital care
by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease.
All the population cooperates in these activities and plans through the social and mass organizations."
latter 20th century
doctor to patient ratio grew significantly
implemented a program of almost universal vaccinations
Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care.
Some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis, hepatitis and chicken pox.
As of 2012, Infant mortality in Cuba had fallen to 4.83 deaths per 1,000 live births compared with 6.0 for the United States and just behind Canada with 4.8.
Did the country try other health care systems
before the present one?
What factors led them to shift
to their present health care system?

Compare the country’s health situation
before and after the present system was instituted?
Present Health Care System
Major features!
Major Strategies Employed!
Budget Allotted for Health Care
BIG role
the government plays
The role the private sector plays
Emphasis is on Primary Health Care and Preventive Services
What we think...
Old remedies for illness were resurrected, herbs and homeopathic treatments were used to great effect.
Specialists from Asia were drafted in to teach the art of acupuncture. Soon major surgery was being performed without the products of a single drug company being involved.
Many simpler drugs were copied and manufactured but
alternative health care
was the main thrust for Cuba.
The principles of the Cuban public health system have made it possible for inter-sector actions to flourish.
These are the principles that allowed their Health Care to flourish...
• Public and social nature
• Accessibility
• No cost
• adequate
application of
Technological Developments
• preventive

• community participation
• intersector approach
• International cooperation

The centerpiece of their system is the community-based polyclinic.
-Each of the
nationwide serving a catchment area of between
30 000
60 000 people.
The polyclinics act also as the organizational hub for 20 to 40 neighbourhood-based family doctor-and-nurse offices, and as accredited research and teaching centres for medical, nursing and allied health sciences students.
, Cuba has about 33,000 family physicians. Specialization in family medicine is a requirement for more than 97% of medical graduates, who spend one internship year and two residency years in training after they receive their degrees.
The Cuban government operates a
national health system
and assumes fiscal and administrative
responsibility for the health care of all its citizens.

There are no private hospitals or clinics as
all health services are government-run
. The present Minister for Public Health is Roberto Morales Ojeda.
Cuba has an extensive public healthcare system, to which all citizens enjoy equal access. Private hospitals, doctor’s practices and other private medical facilities do not exist.
All health-related facilities and services are run by the government
Medical care system has been fiercely adhered to by its political leaders and citizens because of an ideology focused on

- Formation of polyclinics composed of family doctor-and-nurse offices

- equal access to health services, and all services are FREE

-human right rather than a product for economic profit

Primary emphasis on DISEASE PREVENTION

Until some 90 years later, government-run Primary Health Care was relegated to medicine for the poor offered in places called first-aid houses or dispensaries, which were few, under equipped and understaffed. Their main function was to give first aid to the injured, with limitations regarding the quality of actions performed.
In 1964, the Comprehensive Polyclinic was created, an institution that was to become the core of Primary Health Care in the years ahead. There were already some units described as polyclinics, but their scope was limited to doctor’s visits with outpatients.
The tightening of the
US embargo or
the loss of trading
Government reforms and interventions
Most of the work in this system is done by the government. They built schools for teaching health care and medicine. They even created their own pharmaceutical industry to supply basic medications.
This is the main issue to look at why such health care system was formed. This event had a very big impact on the economy of Cuba since most of the medical facilities and commodities come from trading with the US. Such economic effects had huge effect for the budget for the health care system then.
Education and
nature of doctors
in Cuba
In Cuba education is free and is a birthright of every person in the country. It contributes to the formation of the health care system since training or education for the medical arts is always available to those who want to get it.
Before the Revolution, most people could not afford proper medical care. In the rural areas there were few doctors and in the big cities, only the upper classes could afford health care.
For almost 4 decades now, Cuba’s health care system stands out as evidenced by its infant mortality rate of 5/1,000 is near that of the United States. The life expectancy of the average Cuban is also far longer than that of people in any other Latin American country.
Cuba was also awarded
for the achievement of its goal:
"Health for all by the Year 2000"
The great thing about Cuba is the system of providing health care across all classes and making the government of this socialist state liable to all its basic services.
This has been shown to us by the great change given by maximizing their resources and also through reforms economically, socially, politically, and what not.
These changes they have made in their health care system would be possible to apply in the
. Being an archipelago, and being a country with deep spanish influences, It is not impossible that
we can adopt the changes that contributed to how good their country is regarding health.
The questions are...
Are we able to
entrust our wages
to the government?
Do we have trustworthy leaders who will advocate for our rights for proper health care?
And will our culture take in the need for an overhaul in our health care system?
These questions cannot be answered now...
Till then we can look at
and how, being a small and "poor" country, they are able to be a country with a
leading quality health care system


The Health expenditure in Cuba was last reported at 10.63% of the total GDP in 2010.

Total health expenditure is the sum of public and private health expenditure. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation.
Marc Vincent Quiroz
Kim Karen Dumalnos
Kento Takahashi
Jhozel Kim Dominguez
Agnetha Kitong
Altifanie Miranda
Marco Paulo Naoe
Roxanne Quiton
Vincent John Bencila
Efigenia Peralta
Abelardo RM, Candido LP. (June 2005) A Monitoring System for Health Equity

in Cuba. http://www.medicc.org/publications/medicc_review/0905/cuban-


Annual Health Statistic Report 2005: Cuba Health Profile. (2006)


Cuba Pan American Health Organization 2007 Report. (2007) 2. Health in the

Americas. Cuba’s Political Succession: From Fidel to Raúl Castro.



Cuban System of Health.




Cuba’s Health System: Challenges Ahead’. Health Policy and Planning Oxford

University Press in Association with the London School of Hygiene and

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Evenson D. Medicc Review.


Gutierrez S, et al. (2003) Comparison of Four Health Systems: Cuba, China,

Japan and the USA, An Approach to Reality. SouthEast Asian J Trop Med Public

Health, 34 (4)

Hart P. (2006) Doctors for oil - international trade Cuban-style -

Telegraph. http://www.telegraph.co.uk/health/healthnews/3342229/Doctors-


Salud - Cuba's Health System. (2006) http://www.saludthefilm.net/ns/cuba-


Central intelligence agency library retrieved from


dated September 27, 2013


























Morrisset and Champion. 2013. “A different Model – Medical Care in Cuba”

Ullmann, Steven. 2005. “The Future of Health Care in Post-Castro Cuba”


Roselyn Dagdagen
Jackie Te
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