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It can be learnt that socialist Cuba health heaven is a fallacy.

Cuban Anonymous professional, CAP CAP Send letter to journal: Re: It can be learnt that socialist Cuba health heaven is a fallacy. rodolfo_stusser{at}hotmail.com Cuban Anonymous professional

Dear Editor of the CMAJ, Franco et al in Obesity reduction and its possible consequences: What can we learn from Cuba's Special Period?[1-2] highlights wittily healthy physical effects of a hungry/miserable Cuba without energy/transport 1990- 95 �real-socialist period� --unbiased by Moscow huge rent 1959-89 when Cuba made Cold/Hot Wars in America, Africa, and Middle East, but letting out of the analysis the ill-health mental and social effects, key components of human well-being and health, as well as its causes too. The induced progression and regression of a disease as atherosclerosis, handling a risk factor is not new. This was first shown in 1933 by Anitschkov in a rabbit model of diet-induced atherosclerosis that atheromatous lesions would regress on withdrawal of the cholesterol rich-diet.[3] Early studies in humans by Vartiainen and Kaerva, and Wilens in 1947 showed that persons subjected to caloric deprivation (with or without hard labor), were much less likely to have atheromas at autopsy than those who were well nourished (and less active).[4-5] Franco et al observations in the Cuba island prison are consistent with the results in rabbits, in Jews in Nazi concentration camps, and in other studies. On their base suggest a novel health policy/system experiment: to transform Canada on a Soviet central planning state that forcing its free-market economy food and transport prices (reduced for fruits/vegetables and tennis-shoes/bicycles; elevated for high-energy food and public transport-cars/gas), can compel Canadians to loss weight and be healthier physically, although mentally and socially as sick and disabled as are most Cubans today are. Canada is a state that promotes real observance of UN individual freedoms/rights,[6] and of UN living standards/levels norms of its people,[7] so it will not pass over individual education and conscious choice, though these epidemiological results can help educate and take conscience of the benefits to control normal weight through caloric intake and physical exercise and to live much more. I sincerely think that this Cuban experience can be of help, but if it is fully presented why and how the weight loss in the population was achieved, and in what quality of life the population have continued living more years. I am aware of the US colleagues Franco, Caballero and Cooper�s epidemiological limited analysis of a situation they could not live, even fully, if they would have been in Cuba then. I am sure they cannot imagine the very optimistic estimations of figures in Cuban state publications, nutrition and hygiene institutes, statistics bureaus, and paradisiacal views given by state official Ordu�ez for political propaganda purposes. I suggest foreign scholars of the Cuban experience to be very cautious when you observe its great unbalance between the living/working care and healthcare achievements. Franco et al narrow focus analysis on physical bodies with obesity, diabetes, CAD, stroke, and weight loss [1-2] was subtracted of its frame of living and health calamities: a famine with lack of soap, medicines, clothes/shoes, energy/transport and everything suffered by 99% of the Cuban people, due to a leader obstinacy to eternize in power maintaining an under-productive system unable to overcome inequalities, supported by an elite of 1%, who continued its concealed best meals/liquors, hygiene, treatments, national/overseas travels, fortunes overseas, and all possibilities of very rich persons. My elder parents �without any support--, rest of family and I, abruptly lost in regards to 1989 more than 25% of weight, 90% of lipid and 80% of protein daily intake per person, 50% of electricity, and 95% of motor transport, dying my mother of an undiagnosed cardiac failure in uncontrollable diabetes. Cuba shows unsuspected similarities with the Stalinist North Korea�s famine [8] and setback to the Middle Ages in its also 1990-95 �real- socialist period�, due to akin political and economic causes: the authoritarian state failure of denying people their food entitlement from a collapsed public food distribution system, which prioritized the elite and military.[8] Cuba also prioritized paramilitary troops, and the extended foreign tourism �which for 30-years was limited to Soviet bloc military, advisers and tourists. Such entitlement failures of socialist political systems are the source of some of the greatest 20th-century famines: the USSR in 1921�22 and 1946�47; Ukraine in 1932�34; China in 1958�62; Cambodia in 1979; and Ethiopia in 1984�85.[8] In Cuba, the state farms and enterprises had destroyed the agriculture, cattle raising, sugarcane and most industries. Besides, the USSR exigency in 1989 that Cuba must pay for its imports in cash (forgetting 12 billion US dollars debt); the return of 200,000 Cuban military/paramilitary troops/agents from abroad; the growing gigantic and unproductive bureaucracy; the foreign non-socialist tourism opening; the investments in new pharmaceutical products without support of foreign houses; the lost of credibility to obtain credits in Mexico, Canada or any market due to the Cuba 1986 self-cancelled debts/services with the IMF/World Bank (7 billion US dollars), and the secret sacred fortunes of the elite abroad (known as reserves), made that Cuba faced a demand of everything, with �no liquidity� and credits to buy, depending of donations of other allies. Cuba apparently did not have North Korean population 3-5% of deaths, although Cuba death rates in elderly increased 13%.[9] Possible sub- registration could be studied by independent analysts on this matter. Cuba�s potential raise of mortality was muffled by the opening to the US family shipments of food, medicines and dollars since Aug. 1993, and re- generalization of non-socialist foreign tourism out of highly reserved captive tourist poles. Mortality was also softened by the re-opening of the free agro-markets in Oct. 1994, after an exodus of more than 30,000 desperate persons in handcraft rafts with thousands of deaths drowned or eaten by the sharks in the Mexican Gulf. Infant mortality was only transitorily affected,[9] due to a extreme contraction of birth rates by the penury, UNFPA aid in contraceptive hormones, stratospheric rates of embryo transvaginal aspirations (recorded as �menstrual regulations�) not as abortions, in hospitals and polyclinics, and only pregnant/baby care since primary care. Indirect and all-maternal mortalities rose,[9] reflecting a stationary collapse of adult care to date. Amartya Sen, Nobel Laureate observed that famines do not occur in democratic societies because free media and press generate public pressures that compel governments to act. Even when national food supplies are tight, food can be obtained from the international market if famine prevention is prioritised by the government.[8,10] In Cuba were prioritized the political control by military/paramilitary squadrons to squash rebellions of desperate people (as happened in Havana Malecon Ave.), and the secret savings of billions US dollars in Swiss bank accounts of the elite. It is doubtful, with the state handling population projections and death figures 1959-2008 to hide the historical hundred of thousands emigrants and deaths by shot, war, drowned and eaten by sharks (the latter in 1990-2008), the report that the Cuban diabetes, cardiovascular, and all -cause mortality adjusted rates were so reduced.[1-2] It is questionable that they decreased mainly by obesity reduction, since Cubans� rationing card has six-pound of refine sugar per person monthly, a key risk factor for diabetes and atherosclerosis from the 1960s, and since the 1990s sugar is still the �salvation little board�, while smoking, homemade alcohol drinking and stress increased to a maximum. It is also dubious the total incidence of optic neuritis and prevalence of sequels of the peripheral type, which were seen until the 2000s, with the report of cases forbidden, as well as of those of several dengue epidemics. Food supplies will have reached in 1999 pre-crisis levels, due to foreign tourists� consumption, but not to natives� intake levels yet. Transport improved in 2008 to a half of 1958 levels, now with double population. Progress in civil/political freedoms and socioeconomic development are the only means proven to decrease progressively the millenarian inequalities between the affluent and poorest classes in every country of the world, including the living/working care and healthcare inequalities, and to improve public health with a bio-psychosocial concept. A system that goes back most people to feudalism, through the property monopoly of a monarch ruling with terror, captivity, hunger, and extreme poverty again, must be rejected. This is the healthiest thing that Cubans learnt and Canadians can learn too. Whether Cuba healthcare is a good example for Canada, I will pray for the Canadians. Thank you. IMF: International Monetary Fund UN: United Nations UNFPA: United Nations Population Fund US: United States of America WHO: World Health Organization References: 1. Franco M, Ordunez P, Caballero B, Cooper RS. Obesity reduction and its possible consequences: What can we learn from Cuba's Special Period? CMAJ 2008;178 (8). http://www.cmaj.ca/cgi/content/full/178/8/1032 2. Franco M, Ordunez P, Caballero B, et al. Impact of energy intake, physical activity, and population-wide weight loss on cardiovascular disease and diabetes mortality in Cuba, 1980�2005. Am J Epidemiol 2007;166:1374-1380. http://aje.oxfordjournals.org/cgi/content/full/166/12/1374 3. Anitschkow N. Experimental atherosclerosis in animals. In: Cowdry EV, ed. Arteriesclerosis: a survey of the problem. New York: Macmillan, 1933:271-322. 4. Vartianen I, Kanerva K. Arteriosclerosis and war-time. Ann Med Intern Fenn 1947;36:748-758. 5. Wilens SL. The resorption of arterial atheromatous deposits in wasting disease. Am J Pathol 1947;23:793-804. 6. UN. Universal declaration of human rights. New York, NY: UN Publ; 1948. Available: http://www.un.org/Overview/rights.html (accessed May 17, 2008). 7. UN. Report on international definition and measurement of standards and levels of living. New York, NY: U.N. Publ., 1954. 8. Chen LC, Lam D. Perspectives, Book. A penetrating analysis of famine in North Korea. Lancet 2007;370:1897-1898. http://www.thelancet.com/journals/lancet/article/PIIS0140673607617978/fulltext 9. Cuban Health Statistics Bureau. Annual Health Statistics Reports 1973-2006. Havana City: Ministry of Public Health, 1974-2007. http://www.sld.cu/servicios/estadisticas/ 10. Sen A. Development as freedom. 1st edn. New York, NY: Alfred A. Knopf, Inc.; 1999. Conflict of Interest: None declared

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