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Editorial:
Planning for Cuba's transition
The Lancet - Vol. 368, Number 9535, 12 August
2006, Pages 554
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A
Note by de Cuban Journal of Public
Health
August 25 2006
Luis Carlos Silva, Cuban Journal of Public
Health, Editor , National Center of Medical Science
Information.
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Havana, August 21th,
2006
Dear Sir,
After
carefully reading your editorial “Planning for Cuba’s
transition” (The Lancet 2006; 368:553), the Editorial
Board of the Cuban Journal of Public Health has posted a
Note in our site http://revsalud.sld.cu . It can be read
in Spanish and English. We think that your call for the
preparation of a US humanitarian intervention in Cuba to
mitigate the problems that would come under a “period of
rapid and uncomfortable change” is, above all, very
dangerous for our people health. We invite The Lancet
readers to visit our site to know, more deeply, the
point of view of our Journal about the issue. Regards,
Luis Carlos Silva, PhD
Cuban
Journal of Public Health, Editor
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Health Care in
Cuba
August 29 2006
Imti Choonara, Professor in Child Health,
University of Nottingham, Derbyshire Children's
Hospital, Derby, UK.
Frank Varona Rodriquez, Children's
Hospital, Camaguey, Cuba<br/> Maurizio Bonati,
Mario Negri Institute, Milan, Italy<br/> Michael
Rieder, University of Western Ontario, London,
Canada |
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In response to your
editorial ‘Planning for Cuba’s transition’ (Lancet 2006
p 554). We would like to make the following
points.
Firstly, the political future of Cuba
should be decided by Cubans through the electoral system
chosen by Cubans living in Cuba and not by others (in
particular, politicians in Washington or Miami).
Secondly, the greatest economic assistance the US
Government could give to improve health in Cuba would be
to lift the economic embargo imposed upon the island, a
blockade which has overwhelmingly been condemned by the
United Nations.
As doctors with first hand
experience of the health care system in Cuba,1 we can
assure you that it is in excellent condition despite the
economic blockade which makes the purchase of medicines
and medical equipment more difficult.2 The fact that the
under- 5 mortality rate is 7 per 1000 (data for the USA
8 per 1000) and life expectancy at birth is 78 years
(data for the USA 78 years) illustrate this (World
Health Organization, 2004 data).3
Health care is
free and readily available to every Cuban citizen. There
is an excellent system of primary health care which
includes one family doctor for every 125 families. Every
Cuban is seen at least six monthly for a check up by the
family doctor.4 Additionally there is an extensive
system of polyclinics and hospitals. The Cuban health
care system has recently been illustrated as an example
of one of the best systems in the world in relation to
the amount of money spent on it in a recent Newsnight
documentary by the BBC.5
These achievements in
the provision of health care for the Cuba population are
remarkable for such a poor country. The Lancet has
previously been seen as a champion for improving health
care in the developing world. One would have anticipated
a Lancet editorial that:
1. Recognises the
achievement of the Cuban Government in relation to
providing health care for its population.
2. Suggests
that the Cuban healthcare system is studied as an
example of how to provide excellent healthcare in
developing countries.
3. Recognises that one of the
biggest threat to the health of Cubans is the risk of an
invasion either by the armed forces of the United States
or by extremist armed groups in Miami.
We would
assume that neither the Lancet nor its readers would
wish to see Cuba’s excellent health care system
privatised as is currently happening within the UK or
transformed to a model which is dependent upon private
insurance schemes which in turn would deny access to
health care to a significant proportion of the
population. This would be the likely result of a
‘transition’ initiative imposed upon Cuba by the US
government and would not be welcomed by Cubans who are
proud of their current health care
system.
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None |
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References: 1. Choonara
I. Cuban doctors. Lancet 2004; 364:579.
2.
Kirkpatrick AF. Role of the USA in shortage of food and
medicine in Cuba. Lancet 1996; 348: 1489-91
3. Pan
American Health Organization (PAHO). Health situation
analysis and trends in Cuba.
http://www.paho.org/English/DD/AIS/cp_192.htm
4.
Dresang LT, Brebrick L, Murray D, Shallue A,
Sullivan-Vedder L. Family medicine in Cuba:
Community-oriented primary care and complementary and
alternative medicine. J. Am. Board Fam. Pract. 2005.
18;4:297-303.
5. Harris J. Cuba’s healthcare
examined. BBCnews 2006.
http://news.bbc.co.uk/nolavconsole/ukfs_news/hi/newsid_5230000/newsid_5237000/nb_wm_5237070.stm
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Respect for the National
sovereignty of the people of
Cuba
August 29 2006
Mauricio Torres Tovar ,
General
Coordinator, Bogota .
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One of the international
human rights widely accepted in the international
setting several decades ago, is the one that has to do
with the respect for the national sovereignty of the
peoples. Unfortunately, it is one of the most violated
in recent years by nations claiming the respect for
their own sovereignty but, in turn denying it to
others.
In the spirit of the respect for
human rights , we want to express on behalf of the Latin
American Association of Social Medicine, our concern for
the ideas conveyed in the editorial by the The Lancet on
August 12th, 2006, which promote an attitude of
disrespect for the sovereignty of Cuba.
We consider Cuba as one of the nations
in which human rights are most observed, and this
comprises civil, political, economic, social and
cultural rights and, most of all, the respect and
guarantee for the right to health.
Guaranteeing the right for health of a
people, as sufficiently proven by the health indicators
of Cuba, expresses a political will of true commitment
of its Government and leaders, because otherwise it is
not possible to do it.
The responsibility
of the Cuban state regarding the health of its citizens
should be an example for all the nations of the world,
as well as its huge vocation for solidarity, as
evidenced in the field of health by multiple examples of
support to different countries of the world, devastated
by natural catastrophes and to which the Cuban
Government, despite its economic restrictions, has not
hesitated to aid with medicines and health
professionals. It’s worth to remember the offer made
last year by Cuba to the U.S government so as to provide
care for the citizens affected by Katrina hurricane,
which unfortunately was not accepted; as a result, an
opportunity of experience in the management of this type
of situation which could have favoured the American
citizens was lost, and there is no doubt this meant
human losses and greater consequences for the health of
many of the survivors.
Therefore, in our
opinion, the statement made by The Lancet in relation to
the planning for the transition in Cuba, is both
disrespectful and incorrect. What Cuba really needs, is
to strengthen its social and health achievements. As to
changes if any needed, it is the sovereign decision of
the Cuban people implementing them and not at all, a
concern of any “US Presidential Commission for
Assistance”. What should be claimed to the international
community is the cessation of the inhuman economic
blockade to which Cuba has been submitted by the United
States for several decades now.
Dr.
Mauricio Torres
General Coordinator
Latin
American Association of Social Medicine
(ALAMES)
Email:
[email protected]
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| Competing Interests:
Public Health |
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References: Dr. Mauricio
Torres
General Coordinator
Latin American
Association of Social Medicine (ALAMES)
Email:
[email protected]
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Cuba’s Delayed Transition
Needs?
September 05
2006
Anonymous
letter , Cuban
, Cuba.
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Dear Editor of The
Lancet,
I welcome your kind editorial expressing so
valid concerns/uncertainties on our unavoidable Cuba’s
transition, and shall analyse its complex/dangerous
crossroad.
Socialism did not work in any developed
countries [1,2]. Therefore, it would have been
paradoxical theoretically that it had worked in the
developing Cuba, though it was of the most advanced
Third-World countries for 1959. Cuba passed peacefully
through both “World-Wars”, promising to be a Caribbean
Tiger, highly developed as the Asians.
Cuba’s
socialism failed in the 1960s, not because of the U.S.
blockade (broken by the U.S.S.R), but to the
self-blocked system. Cuba’s integral living/health
standards have been unnecessarily sacrificed/devastated:
first, by its alignment with the U.S.S.R. in the “Cold
War” against the First/Third-Worlds; second, by its
alliance with obstinate/ aggressive developing
countries/organizations against the First-World
--peacefully co-operating with transition countries.
Cuba is stealthily crossing a transition since the
1970s, when began to foment capitalist enterprises
overseas and national mixed firms, following East
Europe/China reforms seduced by Yugoslavia’s socialist
market economy. Cuba stopped paying foreign
debts/services (1986), lost the U.S.S.R. concealed
subsidy, about a half of Cuba annual GDP (1959-89), but
Venezuela hiddenly subsidizes nearly a fifth of her
annual GDP (2000-06).
This financial backing allows
Cuba to hide its centralized economy inefficiency,
mystify inherited advances from the capitalist republic
as if they were socialist achievements for propaganda,
to sustain eternally in power its officialdom. (See
chart)
Cuba in 1959 with 6,000 physicians for
6,000,000 inhabitants had advanced living/health
standards and public-mutual-private health system
(Spanish/French/U.S. mix), near North-America level and
over Ireland, Germany, and Japan [3]. In four decades
Cuba graduated fourteen times more physicians while
doubled the population, fuelling a high-density of
cheap-wage-labour and unproductive Soviet-Chinese health
policy/system. Thus, Cuba eliminating its civil/economic
rights, could saved some past trends decreasing
infant-maternal/infectious-diseases morbi-mortality,
birth rate, raising life expectancy, at the cost of a
setback to a generalized low-quality of integral human
life/health.
Cuba’s place in world lowest infantile
mortality in 1958 was doubled from the 14th country to
the 28th country now [4,5]. A worse deterioration has
had its adult/elderly medical-dental care systems,
anchored essentially to diagnostic-therapeutic
procedures/medicines below 1980, hiddenly subsisting
private practice within the public system. The access to
modern/expensive means depends mostly of
foreign-citizenship or Cuban political status,
influence, gift or banned cash in the clinical
black-market. Besides, the massive education/promotion
has conspired against doctors’ quality/motivation,
decreasing the clinical physicians/surgeons’
researches/papers.
One million inhabitants and
several thousands physicians have definitively-emigrated
from Cuba since 1959 and still are. Today, half of
Cuba’s doctors (30,000) work abroad in jungles/mountains
in a temporal-emigration Cuba’s business. Physicians
overseas work much because receive in exchange a slight
relief of the undereat/penury they suffer in Cuba,
improving knowledge/skills in the only foreign-exchanges
they can have; and the regimen obtains financing and/or
political support. Nonetheless, the abandoned Cuban
adult-elder population continues suffering lowest
access/quality health care, because physicians at home
although seem plenty, lack
conditions/motivations.
Now Cubans first need is
liberty of everything, specifically information/dialogue
through all media/Internet. Second, require of modern
countries’ people/professional
bridges/support/consultantship/collaboration to
strengthen Cuba’s civil society, encouraging progressive
regime officials to evolve peacefully. It is crucial to
understand all the paths and be free-to-choice the best
way to reconstruct a prosperous self-sustained country
and efficient health care system, where everybody can
live/work decently/healthy and anyone needs to emigrate,
as was Cuba from 1492-58.
Thanks!
Anonymous letter
--for obvious reasons.
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References:
References
1. Landes DS. The Wealth and Poverty of
Nations: Why Some Are So Rich and Some So Poor? 1st Ed.
New York: W.W. Norton Co. & Inc., 1999. ;
2.
Sachs JD. The End of Poverty. Economic Possibilities for
Our Time. 1st Ed. New York: The Penguin Press,
2005.
3. United Nations. Statistical Yearbook 1960.
12th Issue. New York: United Nations Publ., 1961.
4.
United Nations. Demographic Yearbook 1966. 18th Issue.
New York: United Nations Publ., 1967.
5. 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.
http://www.hsph.harvard.edu/hcpds/wpweb/McGuire_wp1406.pdf
Chart. Chronology of Some Advances in Cuba Until
1958
1492-1958 Self-Sustained Economic and
Infrastructure Growth Establishment.
1728-1958
Royal/Papal Havana (Autonomous) University School of
Medicine Foundation –37 years before the U.S.
1728-1958 Self-Sustained Primary/Medium/Fine
Arts/High Educational (Non ideologized) Policies
Establishment.
1804-1958 Smallpox Vaccination and
Scientific Research Beginnings, by Tomas Romay,
MD.
1804-1958 Self-Sustained Health, Social Security
and Techno-Scientific (Non ideologized) Policies
Establishment.
1840, 1842 Havanan Medical Repertory
Foundation, by Nicolas Gutierrez, MD, and Scientific
Bulletin Foundation.
1840-1958 Medical Journals (Non
ideologized) of Major Specialties Foundation.
1842
Royal/Literary Havana (Autonomous) University Pharmacy
School Foundation.
1861-1958 Royal Academy
(Autonomous) of Medical/Physical/Natural Sciences
Foundation by Nicolas Gutierrez, MD.
1871 Cholera
National Eradication.
1881 Yellow Fever’s
Causal-Chain Hypothesis Discovery by Carlos J. Finlay,
MD.
1881-1958 Havana (Non ideologized) Society of
Clinical Studies Foundation and Many Other Societies
Foundation.
1899-1958 Havana (Autonomous) Nursing
School Foundation by a U.S. Nurse.
1900-1958 Modern
Urban Infrastructure, Energy, Telecommunication,
Transportation, Aqueducts, Sewer Systems.
1900-1958
Network of Modern General and Specialized Hospitals,
Clinics and Sanatoriums.
1901-1958 Havana
(Autonomous) University Dentistry School
Foundation.
1901 Yellow Fever Causal-Chain Hypothesis
Confirmation, by Carlos J. Finlay, MD and U.S.
Doctors.
1901, 1909 Yellow Fever Eradication at
Havana City and National Eradication by General/Specific
Sanitation.
1909-1958 First National Department of
Health of the World.
1909-1958 Network of 500 Foreign
and National Pharmaceutical Laboratories
Establishment.
1909-1958 Wide Network of Drugstores
Handling 40,000 Pharmaceuticals.
1909-1958 Modern
Vaccines and Medicines National Production
Establishment.
1909-1958 Rabies, Tetanus, Malaria,
Tuberculosis, Typhoid Fever, Diphtheria, Gastroenteritis
Morbidity/Mortality.
Markedly Lowered --Within
Others.
1909-1958 Demographic and Health Transition.
Cardiac and Cancer Diseases Became the Two Leading
Causes of
Death, and Stroke the Fourth.
1923
Smallpox National Eradication by Vaccination –26 years
before the U.S.
1927-1958 Finlay Institute for Public
Health Foundation.
1929-1958 Cancer Institute
Foundation.
1937-1958 Tropical Medicine Institute
Foundation.
1950s Cardiovascular Institute
Foundation.
1950s Orthopedic Surgery Institute
Foundation.
Main Sources
-Capote Mir R. La
Evolución de los servicios de salud y la estructura
socioeconómica de Cuba. Parte 1 [Evolution of health
services and socioeconomic structure of Cuba. Part 1].
Rev Cub Adm Salud 5:107-117, 1979.
-López Sánchez J.
Tomas Romay and the Origins of Science in Cuba. 1st Ed.
Havana: Historic Museum of Medical Sciences-Book
Institute, 1967.
-López Sánchez J. Carlos J. Finlay.
His Life and His Work. 1st Ed. La Habana: Ed. José
Martí, 1999.
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an
extraordinary lapse by Lancet
September 06
2006
Tim
Anderson, lecturer in political
economy, Sydney, Australia.
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Yes, i agree with the
above criticisms of the editorial. Adopting the rhetoric
of the Bush administration is an extraordinary lapse by
Lancet, likely to seriously mislead its readers. I have
recently been studying the HIV program in Cuba, and the
misinformation over this program, outside Cuba, is also
extraordinary. This apparent inability to seriously
consider Cuba's health achivements is all the more
tragic when we see the fragmented, expensive and often
ineffective medical aid programs in other developing
countries. The US could hardly help “humanitarian needs”
in Cuba, even if it wanted to. Look at the US response
to Hurricane Katrina.
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| Competing Interests:
None |
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| References: Anderson, T
(2006) The structuring of health systems and the control
of infectious disease: looking at Mexico and Cuba,
Volume 19 (6) | June 30, 2006 | page(s) 423-431,
http://journal.paho.org/?a_ID=524 |
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