Public health in Cuba

The Cuban government operates a much-lauded national health system and assumes full fiscal and administrative responsibility for the health care of its citizens. Historically, Cuba has long ranked high in numbers of medical personnel and has made significant contributions to world health since the 19th century. However, after the Batista government fell in 1959 nearly half of Cuba's 6,000 to 6,500 physicians were among those who left the country, requiring the rebuilding of the health care system. A network of community based primary health care clinics was built across the country with many new clinics in previously under-served rural areas. The number of women doctors has increased dramatically and, as of 2001, women made up more than half the student body at Havana's medical school.

Cuba stands out among third world nations in addressing children's health care. Whereas in most third world nations, death rates in the first five years greatly exceed those of developed nations, primarily due to malnutrition, diarrhea, and parasitic diseases, Cuba's epidemiological profile is closer to that of the United States or United Kingom. Incidence of AIDS is the lowest in the western hemisphere, with each pregnant woman being tested for HIV/AIDS and receiving a full course of AZT produced in Cuba. In 1992 Cuba ranked at the median level in the human development index created by the United Nations Development Program (UNDP). The key measurements were life expectancy, educational attainment, and per capita income. Of 174 nations indexed, Cuba ranked 30th in life expectancy with an average 75.3 years, above Argentina, Chile, and Uruguay. It also ranked high in literacy but had only about half the per capita income of Chile, the Latin American leader in income. According to World Health Organization (WHO) statistics, life expectancy and infant mortality rates in Cuba have been comparable to Western industrialized countries since such information was first gathered in 1957. According to the UNICEF Child Survival: State of the World's Children 2008 Report, Cuba ranks 175 among the world's nations in infant mortality, with 7 deaths per 1000 live births, with Canada ranking better at 180, and the United States ranking worse, at 174 with 8 deaths per 1000 live births.

In depth examination of WHO statistics for Cuba reveals that these statistics are prepared by each government and published unchanged by WHO; thus they have been called into question. Nevertheless, the CIA World Factbook cites life expectancy and infant mortality rates that are similar to those for the USA. It is not clear what sources the CIA used for this, since the data presented seems to be equivalent to that published by the Cuban government; this has led to suggestions that material prepared by Ana Belen Montes (a convicted Castro government agent, arrested in 2001) is still being used by the CIA. However, given the extensive and specific data, which have been promptly published in Cuba since 1970, the high rate of autopsies and the low number of deaths attributed to undefined causes (an important indicator for inaccurate vital statistics), a high level of confidence can be placed in Cuban health statistics. Cuban officials have acknowledged that some health care indicators worsened during the 1990s after the loss of Soviet aid and while the United States embargo of health supplies remained in effect.

A separate, second division of hospitals cares specifically for foreigners and diplomats. While tourists can get health care from public clinics on an emergency basis, they are expected to use a fee-for-service health care network called "Servimed" for non-emergency health care needs. There are about 40 Servimed health care centers across the island. Many foreigners travel to Cuba for reliable and affordable health care.

Cuba provides medical care as foreign aid, providing free care to victims of disasters, including 16,000 victims of Chernobyl, and sends medical teams to scores of poor nations, numbering some 26,000 medical personnel as of 2005. Teams of Cuban doctors have been sent to Haiti and the poorest nations of Africa to fight malaria, TB, and HIV. In 1996, at the request of the South African government, Cuba sent 600 English-speaking doctors to make up for the shortfall caused by the emigration of South African doctors. By 2002 80 percent of the doctors in rural South Africa were Cuban. Cuba has had up to ten percent of its doctors serving abroad, fielding more doctors than the World Health Organization. Cuban doctors have won a reputation for being willing to endure primitive living conditions, for being able to improvise when equipment and supplies are lacking, and for maintaining warm relationships with the local population.

Cuba spends about twice as much of its GDP on health care, about 6.6%, as the Latin American average, maintaining a ratio, as of 2001, of one doctor per 150 families. Nevertheless, Cuban doctors are not well-paid by international standards. The San Francisco Chronicle, The Washington Post, and NPR have all reported on Cuban doctors defecting to other countries. According to the San Francisco Chronicle, at least 63, and perhaps hundreds of the approximately 20,000 Cuban doctors sent to work in the barrios in Venezuela, have deserted, in part, because their salary in Cuba is only $15 per month. The United States has announced a policy of preference for Cuban medical workers who seek asylum.