Two Letters Combined Submitted on March 27 & 30, 2006, to Science Journal
Rodolfo J. Stusser
Semi-Retired Professor of Clinical & Health Research
F # 256 apt. 2 interior /11-13 Vedado Havana 10400 Cuba
Tel/fax: (537) 832-3461
http://havanacenter.familydoctors.net, [email protected]
Richard A. Dickey
Semi-Retired Professor of Medicine & Endocrinology
1941 20th Ave Dr NE #56, Hickory, NC 28601
Tel/fax: (828) 327-7269
Robert L. Kriel
Semi-Retired Professor of Neurology Pediatrics & Pharmacy
Linda E. Krach
Semi-Retired Professor of Rehabilitation Pediatrics
116 Malcom Ave. SE, Minneapolis, MN 55414-3502
Tel: (612) 379-4995
Fax: (612) 904-4295
[email protected], [email protected]
Thomas E. Norris
Professor of Family Medicine & Health Services
University of Washington School of Medicine,
Seattle, WA, 98195-6340, USA.
Tel/fax: (206) 685-3466
Letter 1: The role of economics in the health of the poorest community
Jon Cohen makes a very deep critical analysis into the biomedical research paradigm. ("The new world of global health," News Focus, 13 Jan, p. 162). However, global health solutions in low-income countries depend also on economic factors and solutions, which in turn need basic, applied and action research as well.
In the past nine millennia, human development has changed dramatically with economic growth. In the past, practically all people had to survive unending famines, epidemics, miseries, local wars, and political despotism, with primitive knowledge, technologies, sanitation, and natural medicines. Until 1750, most of the one billion people in the world still lived in extreme poverty. However, from then to the 2000s, a global market-based international economy and social sustainable development have spread industrialization, wealth, democracy, and technological-scientific progress. This has been associated with an increasing middle class coupled with a declining poor class and, unfortunately as well, environmental degradation, wars, and terrorism (1,2). Fortunately, illiteracy, ill health and poverty have been more than halved and life span and living standards have been more than doubled. In 2005, in spite of the existence of advanced knowledge, technologies, sanitation and medicine, half of the world’s 6.3 billion people still live in closed overbearing systems and 45% in overall poverty, including 1.1 billion in extreme poverty (1). Faster economic and social advancement are needed.
The Millennium Village Project works with the African civil society in a curative-preventive strategy for the poorest little isolated rural village. It uses a clinical economics approach to health and education, agriculture and infrastructure for its families (ill economic cells), merging the 1960s approach of the medicine in the community with a self-sustaining economy (1). It investigates how to promote healthy lifestyles into a broader bioeconomic-psychosocial paradigm. This project is being complemented by the Millennium City Project (3).
References
1. Sachs JD. The End of Poverty. Economic Possibilities for Our Time. 1st Ed. New York: The Penguin Press; 2005.
2. 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.
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Letter 2: Self-Sustained and Subsidized Public Health Policies
While we agree (1) with Franco, Cooper and Orduñez (“Making sure public health policies work,” 24 Feb, p. 1098) that Cohen’s approach to global health (2) “focuses on technology and research, ignoring evidence from public health care systems,” we disagree that “evidence of an approach that works can be found in the experience from Cuba [only] over the last four decades.”
From 1962 to 2006, an intensive, cheap labor Soviet-Chinese health system in a heavily subsidized and centralized economy has maintained Cuba historically good health trends. The last healthcare achievements stated by Franco et al, resulted from different socioeconomic, sanitary-scientific policies working for more time.
Cuba founded University Medical School (1728), smallpox vaccination and research (1804), medical journals, centers, associations, an Academy of Science (1861), eradicated cholera (1871) (3,4). From its independence in 1902 to 1958 Cuba accelerated its self-sustained socioeconomic, sanitary-educational and cultural-scientific growth, having large immigration, and small emigration --especially of physicians. Carlos J. Finlay (discoverer of yellow fever’s causal-chain in 1881) created the Cuban Department of Health (1909), eradicated yellow fever and smallpox. Institutes for Public Health, Cancer, and Tropical Medicine, were created (1927, 1929, 1937 respectively)(4,5). Cuba produced modern vaccines and medicines, markedly lowered morbidity/mortality from rabies, tetanus, malaria, tuberculosis, typhoid fever, diphtheria, within others, until 1950s. Concomitantly, cardiac and cancer diseases became the two leading causes of death (6,7).
In 1957, Cuba had 32 deaths at < one year/1,000 live births (world fourteenth lowest), life expectancy 62 years, one physician/1,000 inhabitants, modern infrastructure, network of hospitals/clinics and transportation. Cuba had the lowest infant mortality rate for all second/third world countries, lower than Ireland, France, Belgium, Germany, Luxembourg, Israel, Japan, Austria, Greece, Italy, Spain and Portugal [8-10].
It has taken two centuries, not a few decades, for major healthcare advances to evolve in Cuba. Self-sustained socioeconomic growth should not be underestimated.
References
1. Stusser RJ, Dickey RA, Kriel RL, Krach LE, Norris TE, The Role of Economics in the Health of the Poorest Community. In Review in Science.
2. Cohen J, Science. 311 ,5758, 162 (2006).
3. López Sánchez J, Tomas Romay and the Origins of Science in Cuba (Historic Museum of Medical Sciences, Book Institute, Havana, ed. 1, 1967).
4. López Sánchez J, Carlos J. Finlay. His Life and His Work (Ed. José Martí, La Habana, ed. 1, 1999).
5. Capote Mir RE, 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).
6. Arocha Mariño C, La economía y la salud pública en Cuba en la década de 1950 [The economy and public health in Cuba in the 1950s], Rev Cub Salud Pública 24, 134-140 (2000).
7. Capote Mir RE, La Evolución de los servicios de salud y la estructura socioeconómica de Cuba, parte 2 [Evolution of health services and socioeconomic structure of Cuba, part 2], Rev Cub Adm Salud 5, 225-253 (1979).
8. United Nations, Statistical Yearbook 1960, (United Nations Publ., 12th Issue, New York, 1961).
9. United Nations, Demographic Yearbook 1966, United Nations Publ., 18th Issue, New York, 1967).
10. McGuire JW, Frankel LM, Dimensions and Determinants of Mortality Decline in Pre-Revolutionary Cuba (Harvard Center for Population and Development Studies, Working Paper Series. vol. 14 no. 6. Cambridge, MA, 2004).