cmaj.ca -- Thank you

Dear CMAJ Editor,

I sincerely appreciate Dr. Wilbert J. Keon�s �Einsteinian� analytical effort,[1,2] and will contribute to both article/report, with clarifications and insights usually omitted in our Cuban elite-officers� expositions.

Cuba is giving lessons on maternal health and early childhood development, since 1900 and even before.

Our soviet primary healthcare (PHC) cost-effectiveness is hidden in our forced equity at-the-bottom. Most captive physicians (working as nurses/cleaners/sanitarians too) earn, less than US$1 dollar-daily (with forbidden private-practice, exchanges/visits abroad), independently of their work quantity/quality. Cleaners/sanitary assistants can earn up-to US$ 2 dollars-daily. Elite-officers selected by our unique-leader (by political records), earning between US$400-4000 dollars monthly by under-the-table, receiving gratis state-cars, best homes/hotel-stays, often trips abroad with extra money, are in charge of letting perplexed free-world/UN missions with paradisiacal system�s successes.

Human development in our long-suffering Cuba is more an aberration than a world outlier deserving wide-spectrum study with unofficial-information from inside-sources too. While officers report best maternal/infantile physical health and education PHC/indexes,[3,4] they hide our child mental and social repression since the uterus (causing chronic dysfunctions, illnesses and disabilities non-classified yet). Obliged indoctrination by state school, mass-media, and social-control organisms of an atheist, partial/subjective view of reality, forbidding critical thinking, free readings/writings, initiatives/associations, studies/works, as well as free expressions are also concealed.[5-8]

Although the revolution re-tyrannized and re-impoverished 98% of Cubans lives to worse levels than in 1800, it claims for all social advances. Since the 1950s, Cubans had heart-diseases and cancer as leading causes of death.[9] Cuba healthcare system 1900/1928-1958 led all Latin American countries at reducing infant-mortality-rate (IMR) and raising life expectancy-at-birth (LEB). In 1959-1990/2007, Cuba had a worse performance,[10-12] with the same inherited hospitals, confiscated mutualist/private clinics, pharmacies/labs, and high-qualified workforce.

Cuba had an original headstart in many social indexes. Some of them are as follows: In 1957, Cuba had the lowest IMR (32 x 1000 live births) in Latin America, second in the developing world after Cyprus (31), and third in America after Canada (31) and the US (26). Cuba also had the third highest LEB (64 years), physicians� density (1:999 inhabitant), and third lowest fertility-rate (3.7), after Argentina and Uruguay {table}; and fourth highest adult literacy (80%), after Argentina, Chile, and Costa Rica.[9-16]

Cuba until 1958 was a rapidly, but unevenly developing nation pro-freedom, pro-market, pro-export, with powerful labor unions. Its 6 million people were producing annually, one ton of sugar-cane and one head of cattle per-inhabitant, urbanizing/building modern houses in poor rural-villages/slums, developing the sixthLatin American�s economy, exporting almost the same than Mexico (with a fifth of its people), decreasing high-income inequality, without external military conflicts. Today, Cuba with 11 million captive people is producing yearly 2 million, tons of sugar, and heads of cattle, occupying with state-offices more than 5% of previous housing/buildings, letting housing/infrastructure deteriorate, and fostering world military-conflicts against the US and rest of free-world.[5-15]

Information leaked out from Russia, has revealed that in 1948-1953 Joseph Stalin secretly recruited Cuban chiefs, planned and carried out the soviet troops invasion of Cuba, America/Africa, and Asia-Oceania.[17] Cuba was deceived/captured as Russian satellite in 1959 --and still is. With exceptional records in world-class clinical, lab medicine, and public health since the 19^th century (which Russia still lacks),[3,4] Cuba was boosted as the totalitarian socialism world�s health showcase, eclipsing all the progress at least from 1858-1958, to attract peacefully naive peoples.

Stalinist/Maoist voluntarism in Cuba to reduce its IMR below the US� index began in 1961, when the Alliance for Progress in America tried to halve the countries� IMRs for 1970. Cuba�s soviet militarization, socioeconomic/political chaos, assassination of military and opposition, confinements, impoverishment, famine, and setback, caused in 1959-1969 non-reported infant and adult mortality increases and life expectancy decrease. This distorted forever, the balanced and harmonious dynamics of our healthcare, as did the 1969-1970 �Ten-Tons Sugar-Making� with our advancing economy. Since 1961, elders and adults have stayed underserved for five-decade deprived of their previous medical/dental quality of care and welfare, being preserved only better quality of care for babies and women, in its pregnancies, intensifying abortions/sterilizations. Since the midd-1900s, low quality of care has declined even further, due to greater diversion of medical workforce, medicines/supplies for political-ideological activism abroad.[9]

Our 50-year unique-leader justifies GDP per-capita 1957-2007 stagnation US$2406-2700 (1990-Int.-GK)[18] {table},with the US commercial embargo in 1962 (due to Cuba�s confiscations and cold war), and Russia�s exigency of commerce in cash in 1989 (due to Cuba�s US$20 billions debt). Thus, he attempts to hide the inefficient central planning,[9-11] hostile/huge government secret military expenditures in world-class intelligence and armies.

There is no space to detail the healthcare deformation and highest-costs that Canadians would have to pay with our Made-in-Russia�s PHC-polyclinics� services of much lower-quality than our previous clinics/hospitals. Please, ask the Germans why they did not generalize their Eastern polyclinics-network in 1990. Maternal homes extract pregnant women from chronic-malnutrition due to rationing-card and lowest-wages. Our early childhood development collaborative approach is mostly theoretical propaganda, hiding our decadent/moribund system, where Cubans live confined in a fictitious interior-world without real-information. Our family foundations were disintegrated and the paternal authority snatched by all state-institutions since 1959. The 50-year �New Man� project of a communist-android has failed. The young people do not want to work in state-jobs; they try to earn money in the streets, and for that, fill our prisons. In Cuba, only top bureaucrats and foreigners eat and live as God commands. In our context �Educate Your Child� program, tries to prepare parents/child out of state-control to obey state-programs, as to do forced work in agriculture far from home with sexual promiscuity since secondary school, military-service, or emigrate abroad as a spy or a guerrilla-fighter. All the rest is fiction, as to teach parents to feed their child with fruits/vegetables/proteins, which they cannot buy with miserable state-wages. Communist bureaucrats used to report all programs in execution as successfully materialized independently of reality. A cardiological example: Thrombolysis post-MI is as rare in polyclinics as revascularization procedures post-MI/CAD-ischemia in hospitals are. Our historical well-trained/high-qualified physicians have decayed with massive hospital- and community-based education since 1962 and 2002 (without open internet-access). Serious own PHC-research by generalist-practitioners is not a priority and is practically non-existent. There is only socioeconomic/political surveillance by surveys and sanitary-inspections invading home-family privacy.

Marginalized Canadian populations� solution, needs the study of primary living and health care initiatives that besides accepting and caring them (as they are), enhance their free integration to Canada�s advanced society. This only can be achieved applying freedom in all its socioeconomic, civil, and political dimensions to development and human rights efforts {e.g. Cuba (1900-1958), Costa Rica, Chile,[9-12] �Croatia, Estonia, Czech Republic, Slovenia, Cyprus, South Korea, and Taiwan}.[3-4,7-8]

A comprehensive approach improving PHC within primary living care and civil society empowerment, is being tested in the Millennium-Villages-Projects in Sub-Saharan Africa.[19] It cannot be successful PHC and education for all, without primary living care for all.

Godspeed!

Glossary :

UN: United Nations

1990-Int.-GK$: 1990 International Geary-Khamis $ Dollars

IMR: Infant Mortality Rate

LEB: Life Expectancy at Birth

GDP: Gross Domestic Product

MI: Myocardial Infarction

CAD: Coronary Artery Disease

References:

1. Keon WJ. Cuba's system of maternal health and early childhood development: lessons for Canada. CMAJ 2009;180:314-316. http://www.cmaj.ca/cgi/content/full/180/3/314?etoc

2. Senate of Canada, Subcommittee on Population Health. Maternal health and early childhood development in Cuba: second report of the Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology. Ottawa (ON): The Senate; 2008. Available: www.parl.gc.ca/39/2/parlbus/commbus/senate/com-e/soci-e/rep-e/rep08feb08-e.pdf (accessed 2009 Feb. 6).

3. UNICEF. The State of the World�s Children 2009. New York, NY: UNICEF All Statistical Tables; 2009. Available:

http://www.unicef.org/sowc09/docs/SOWC09_all_tables.pdf (accessed 2009 Feb. 6).

4. UNDP. Human Development Index report, 2007/2008. Available: http://hdr.undp.org/en/media/hdr_20072008_en_complete.pdf� (accessed 2009 Feb. 6).

5. UN. Universal Declaration of Human Rights. New York: UN Publ; 1948. Available: http://www.un.org/Overview/rights.html (accessed 2009 Feb. 6).

6. UN. Report on International Definition and Measurement of Standards and Levels of Living. New York: UN Publ; 1954.

7. Freedom House. Freedom in the World 2008. Annual global survey of political-rights and civil-liberties, 2008. http://www.freedomhouse.org/ (accessed 2009 Feb. 6).

8. Heritage Foundation. Index of economic freedom. WCAS, 2007. Available:� http://www.heritage.org (accessed 2009 Feb. 6).

9. Anon. Cuba's delayed transition needs. Correspondence and e-Letter. Lancet 2006;368(9544):1323. (Oct 14) http://www.thelancet.com/journals/lancet/article/PIIS0140673606695445/fulltext

10. Romeu JL. More on the statistical comparison of Cuban socioeconomic development. Proceedings Cuba in Transition ASCE Meeting 1995;(5):293-301. Available: http://lanic.utexas.edu/la/cb/cuba/asce/cuba5/FILE24.PDF (accessed 2009 Feb. 6).

11. Smith K, Llorens H. Renaissance and decay: A comparison of socioeconomic indicators in pre-Castro and current-day Cuba. Proceedings Cuba in Transition ASCE Meeting 1998;(8):247-259. Available: http://lanic.utexas.edu/la/cb/cuba/asce/cuba8/30smith.pdf (accessed 2009 Feb. 6).

12. McGuire JW, Frankel LM. Dimensions and determinants of mortality decline in pre-revolutionary Cuba. Harvard Working Paper Series, vol 14, no 6. Cambridge, MA: Center for Population and Development Studies, 2004. Available: http://condor.wesleyan.edu/jmcguire/ResearchFolder/McGuireFrankelHCPDS.pdf �(accessed 2009 Feb. 6).

13. UN. Demographic yearbook 1955-1970. New York: UN Publ; 1956-1971.

14. UN. Statistical yearbook 1955-1970. New York: UN Publ; 1956-1971.

15. UNESCO. Progress of literacy in various countries; World illiteracy at mid-century. Monographs on fundamental education VI, XI. Paris: UNESCO Publ; 1953, 1957. Available: http://unesdoc.unesco.org/images/0000/000029/002930eo.pdf� (accessed 2009 Feb. 6).

16. Cuban Health Statistics Bureau. [Annual Health Statistics Reports 1973-2007. Havana: Ministry of Public Health], 1974-2007. (Last 13 years) available in: http://www.sld.cu/servicios/estadisticas/ (accessed 2009 Feb. 6).

17. Andrew C, Mitrokhin V. The world was going our way. The KGB and the battle for the third world, 1st ed. New York: Basic Books, 2005.

18. Groningen Growth Development Center. Total economy database, and Angus Maddison historical statistics database, 2008. Both Available in: http://www.ggdc.net/ (accessed 2009 Feb. 6).

19. Sanchez P, Palm C, Sachs J, Denning G, Flor R, Harawa R, et al. The African Millennium Villages. Proc Natl Acad Sci U S A. 2007;104(43):16775-80. http://www.pnas.org/content/104/43/16775

Table

Cuban democracy 1900-1958 and totalitarianism 1959-2007.

Index� /� Year	1900 �	1957	2007
Infant mortality rate < 1yr ( x 1000 live births)� (world lowest rate position) *	195 (33rd)	32 (14th)	5 (33rd)
Life expectancy at birth (years)	32	64	78
Total fertility rate	5	3.7	1.4
GDP per-person [1990 Int. GK$] �(GDP calculated by World Bank norms)��	1400	2406	3400 (2700)
Political-rights/civil-liberties, world ratings (% of 30 UN-articles real observance)***	9 (40)	5 (80)	13 (10)
Economic freedom index, world rank	50	30	156
Human development index, world rank (plus repressed human liberties/rights)***	40	30	48 (>100)
Extreme poverty population percent *** (earning state-wages < 1 US$ dollar-daily)	66	33	98
% people access to low-quality emergency, interned & ambulatory health care ***	50	75	98
% people access to high-quality of life, work, education & health care of elder/adult ***	10	25	2

*Including Hong Kong, Macau, and Taiwan.

**Per-capita estimate adjustment in 2007 excluding medical services overseas, by World Bank�s standards

***Author�s suggested indexes and estimations with all the data at hand.

�

Main Sources: [3-4,7-16,18]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH

Copyright 1995-2009, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.

Conflict of Interest: