Weight changes and health in CubaBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1777 (Published 09 April 2013) Cite this as: BMJ 2013;346:f1777
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Five hundred years ago, in 1516, a text was printed which has endured as a reference down the centuries. It was "Utopia," the penmanship of Sir Thomas More, a lawyer and politician who had the proclivity of mind to write fiction as a way of uncovering ideas. His tale was about a imaginary isle, Utopia, on which lived an equalitarian society. In conceiving such a work the fictionist was plainly inspired by the geography of his home – the island of Britain.
In the mind of Sir Thomas More the Republic of Utopia was a place distinguished by its adherence to fairness. The British term "the commonwealth," appearing in the same era, refers to the common good. Equality in healthcare is a Utopian ideal that has been pursued in the British Isles since the 1940s. Over multiple generations the National Health Service has reduced disparities in health across the layers of society.
Rarely featuring in the consciousness of Britain, Cuba, the largest rock in the Caribbean Sea, also has a health system funded by the state. Compared to Britain the island of Cuba is a place of modest affluence. But what startles is how this nation of 11 million in the Caribbean attains a high prevalence of wellbeing. Uppermost for the World Health Organisation, life expectancy and infant and maternal deaths in Cuba equal those of the richest nations.
The doctor-to-patient ratio is crème de la crème :
Country Number of doctors Population
per 1,000 population in millions
Cuba 6.7 11
Germany 3.9 81
Denmark 3.5 5
Australia 3.3 22
United Kingdom 2.8 63
Japan 2.3 127
United States 2.4 308
China 1.5 1,338
India 0.8 1,205
Mozambique 0.04 24
2010 figures from World Health Organisation
Cuban quirks reveal why a good health service exists in a country which, under usual prejudices, might be expected to run shoddily. Fidel Castro, revolutionary of Cuba, who seized office in 1959 and retired a few years ago in 2008, made Public Health a central mission. Communist Cuba had an affinity with the Soviet Union and duly received the patronage of the Kremlin in the Cold War of the 1950s to 1980s. Soviet loyalties alienated Cuba from nearby America, 90 miles away, and the Americans blocked trade with Cuba, an embargo which has relaxed a fraction only in these 2010s.
Excluded by America, Communist Cuba became dependent on the Soviet Union for trade and military support. But the Cuban-Soviet pact was severed in the early 1990s when a fragmentation of the Soviet Union left Cuba entirely stranded. These vicissitudes evoked disquiet in the British Isles. Endorsing opinion in the Lancet, the British Medical Journal argued that the American trade blockade should not include clinical supplies. For Cuba, a shipping of medicines from other than the Soviet Union could not be a measure of any longevity. The cost would be too high.
Of varied mixture, white, black and hybrid, the Cuban people showed their versatility by engineering their own pharmaceutical industry. Theirs is a state-owned Little Pharma in the developing world that today focuses on vaccines and cancer therapies rather than on drugs for erectile dysfunction and high cholesterol, the preference of the Big Pharma of the rich countries. Successful in providing for its own citizens, Cuba exports low-cost medicines to the lower income world and frontmost as customers are the nations of Latin America.
Another philosophy of Cuba bolsters the surrounding crescent of Latin America. Cuban medical schools train students for free, paying for their education, board, and providing a sum for daily essentials. Students arrive from over a hundred countries, chiefly from Africa, Asia and Latin America, and impecunious neighbourhoods in the United States also send their sons and daughters. To sustain the free programme, contracts exist in some instances such as Venezula furnishing Cuba with oil in exchange for the education of its students.
From poor rural communities, more than half of the students are women who ordinarily have no chance of qualifying as doctors. Possessing substantially more places at medical school than Britain, the Cuban system repatriates well-trained physicians to disadvantaged towns and villages to perpetuate healthcare where none exists. Calculated as the largest on the planet, the Latin American Medical School of Havana, Cuba, is an institution that hinges on communal values, the motto "to train the world’s doctors." Quoting a pass rate of 80%, the alma mater of thousands in Havana confers an MD degree that is recognised by America despite the Cuban-American inimicality.
Production of doctors is patently a national forte in Cuba. Whilst some nations have a chronic scarcity of physicians the surplus in Cuba has been immeasurably valuable in crises. Little Cuba had the reserve and gumption to rescue Pakistan when the earthquake of 2005 brought instant suffering to 1.5 million people. Two years ago, in 2014, Cuba unsparingly sent a squadron of doctors to West Africa when the Ebola Virus hazed through the region. Supported by the World Health Organisation, Cuban physicians, in their hundreds, continued to toil in these calamity-stricken areas after a tapering of interest from the global media.
Cuba delivers care that is the envy of countries of similar texture in SubSaharan Africa. Doctors are easily available (Accessibility), the care is of a good standard (Quality) and a wastage of resources is avoided (Cost-effectiveness). Medical care in the community is especially noteworthy. But a parochial picture would be painted if wider aspects were not acknowledged. Paid by the state, Cuban doctors earn a salary that prompts a crowded emigration, and the penchant is for America. Other doctors, speaking with impunity from overseas, claim that any celebrated health indices are based on fudged figures released by the Cuban government. Nullifying some of these views are the evaluations of major health organisations which have concluded that, all factors considered, Cuba offers astoundingly effective healthcare for a lower income country.
Giving well-taught doctors to the poorest areas, for free, Cuba is a reference point on the world map of healthcare, and the reaction of this isle in the Caribbean to mass tragedies abroad reveals an estimable attitude. Cuban state broadcast opens every evening with a one-line poem : "To be cultured is to be free." Utopia. Long live Cuba. Viva Kooba.
Competing interests: No competing interests