November 2012        


Cuba’s universal health care

In January 2010 Haïti was struck by a major earthquake, which killed at least 220,000 people, injured 300,000 more, and left 1½ million people homeless. After the earthquake the media showed international aid pouring in from the world’s leading countries. The United States received particularly positive coverage, sending a 1,000-bed hospital ship with a 550-person medical staff and staying for seven weeks, in which time they treated 871 patients, performing 843 surgical operations.
      However, missing completely from media attention was the contribution made by Cuba. For the first seventy-two hours after the earthquake Cuban doctors were in fact the main medical support for the country. Within the first twenty-four hours they had completed 1,000 emergency surgeries, had turned their living quarters into clinics, and were running the only medical centres in the country, including five small hospitals that they had previously built.
      Before the earthquake 344 Cuban doctors were already working in Haïti, with another 350 sent following the earthquake, along with 546 graduates from around the world who had been trained in Cuban medical schools. By the end of the initial crisis they were working throughout Haïti in twenty rehabilitation centres and twenty hospitals, running fifteen operating theatres, and had vaccinated 400,000 people.
      This is a remarkable achievement for a country that the United Nations still considers a developing country.
      What is more remarkable is that this is not the only occasion on which Cuba has made positive interventions during natural disasters. In 2005 Pakistan was hit by a massive earthquake, leaving 75,000 people dead and 120,000 seriously injured.
      As in Haïti, large countries competed with each other about sending aid, and our media kept us informed of how much was being raised and promised. (In reality, much of this assistance never materialised.)
      Again the media failed to report on Cuba’s contribution. It sent 2,465 medical workers, including 1,400 doctors. Most aid teams left after five weeks, but the Cubans stayed for eight months, and many are still there. They have treated more than a million people and carried out 12,400 major surgical operations. In addition they set up, and left behind, thirty-two fully equipped field hospitals. No other country came close to providing this level of assistance.
      In 2005, when Hurricane Katrina struck New Orleans, Cuba offered to send 1,200 doctors to the area, but they were turned away.
      The actions of Cuba in providing such impressive medical response raise a number of questions. How, as a Third World country, was it able to provide assistance that surpassed that of fully developed First World countries, such as the United States and Britain? Why are these medical interventions given little or no media coverage?
      To answer the how and the why requires looking at the Cuban attitude to health care. Essentially the Cubans see education and health care not as commodities but as the most basic of all human rights. They believe that free and universal access to education and health is intimately linked to human dignity and social harmony.
      Since the victory of the Cuban Revolution in 1959 Cuban society has been developed and geared towards the provision of these rights.
      Cuba now has undoubtedly one of the best health services in the world. All Cubans have access to free health care. Cuba is ranked second in the world for number of doctors per capita, with 5.6 per thousand people. This is in sharp contrast to the United States and Britain, which rank 52nd and 55th, respectively, with only 2.2 and 2.3 per thousand.
      What’s more is that Cuba’s achievement in health care has not been confined to its own people but has made a huge global impact.
      Only two years after the success of the revolution Cuba was allowing patients from the Third World to come to Cuba for free, high-quality treatment. As its domestic health service grew it began sending volunteer health workers abroad. From 1967 Cuban trainee doctors have been required to work overseas for at least a year in order to complete their training.
      Eventually Cuba set up medical brigades that travelled across the world to health trouble-spots. These brigades not only treat sick people but also train local people in hygiene and basic health care and construct clinics. When the earthquake hit Haïti, the Cubans already had a medical brigade in the region, which included 575 doctors and medical workers. Similar brigades are now serving in Paraguay, Mexico, Venezuela, and Cambodia.
      In 1999 Cuba established the Latin America School of Medical Sciences (now the Americas School of Medicine). This school accepts students from around the world who cannot afford to attend medical school in their own country. All are on a full scholarship, including board and lodging. The only condition attached is that they return to their own countries and establish community and health schemes among their own poor.
      By 2006 there were ten thousand such students at the school, from twenty-nine countries. In 2007 eight American students were among those graduating, and, like the others, they are contractually obliged to go home and practise medicine among the economically disadvantaged.
      How has Cuba managed all this? It is a Third World country, whose economic growth has been severely hindered by a continuing economic blockade imposed by the United States forty-nine years ago. Yet it has achieved all this in spite of the blockade and losing its main economic partner when the Soviet Union collapsed.
      Part of the answer can be seen in how Cuba manages the meagre resources and wealth that it has. The most common way to measure a country’s economy is by looking at its gross domestic product. Cuba ranks 93rd in the world in GDP. However, if you look at its human development index, which is used to measure human well-being in society, Cuba is ranked 50th.
      What does this mean? Essentially it means that Cuba has a more equal society, that it uses what resources it has to improve the well-being of all its citizens. It means that Cuba is spreading its wealth further when compared with such countries as the United States and Britain, which rank higher in GDP but lower in HDI, meaning they are not using as much of their wealth to benefit human well-being as they could do.
      So what is the difference between Cuba and the world’s leading states? Why does it choose to spend more of the country’s wealth on human well-being?
      The Cuban economy, unlike that of capitalist countries, is not based on competition: put simply, it is a non-profit society. It judges wealth not by how many people are materially rich but by how equal society is. Are people well educated? Are they healthy? Have they job security and housing? Do they play an active role in the community?
      The Cubans believe that in order to create a more equal society they should invest their resources and wealth in increasing the well-being of the whole society—not in creating profit for individuals or big corporations.
      It is this approach to the economy that has allowed the Cuban health and education systems to flourish. If Cuba can achieve this on the little resources it has, and in the face of an economic blockade, imagine the changes in society that the world’s wealthiest countries could achieve if they took the same approach to how they distribute the resources in society, if they put human well-being ahead of creating profits for the private sector.
      So, why do we not see Cuba’s example of equality, health care and education promoted in our media as something to strive towards? One answer is the continued aggression of the United States towards Cuba. The Bush government designated Cuba as part of an “axis of evil,” and American vilification and attacks on Cuba continue and with the removal of the blockade under Obama seeming as unlikely as ever.
      The real threat posed by Cuba is that it challenges the domination and the rationale of the capitalist values of competition and individualism. Global neo-liberalism demands free trade and unregulated markets to create more profit and more wealth for a few. Neo-liberal economies are based on competition, and in any competition there are winners and losers. Because of this, neo-liberalism cannot provide an equal society. It cannot achieve world peace, it cannot end world hunger, it cannot provide real and lasting solutions to economic crisis, and it cannot solve the problem of environmental degradation. It considers health something to be bought and sold.
      All over the world health care is now being privatised, and we are being told that this is the only option. Workers everywhere are subject to unregulated markets, meaning there is no job security, no matter whether you work in a call centre in Derry or a factory in the United States: your job can be moved at the drop of a hat to another part of the world.
      We are told by governments and the media that this is the way things are, that’s the way the world works, and we should just accept it. And it is here that Cuba poses the real danger.
      Cuba presents a practical and tangible alternative: it shows another approach to providing health care, one that views it as a right and a means to human dignity, not a commodity with which to create unshared profit. It is backed up by a different approach to running an economy, one that strives to provide wealth for all and not for a few.
      There is poverty in Cuba; but Cuban society does not accept it as inevitable, it does not lay the blame on the weakest in society by suggesting that they are lazy or selfish, and it actively seeks to solve the problems it faces, by encouraging collective values and responsibility rather than individualism and consumerism.
      Given the poor state of our own health service, should we not be looking to the successes of Cuba? In the face of continued economic crisis, should we not be considering a different approach to how we run our economy and share our resources?
      It is important for all workers, especially young workers, who will be left to deal with the economic mess created over recent decades, to look far and wide for alternatives and solutions. It is crucial that we hold the Cuban experience up to as many people as we can. We should lobby our elected representatives to follow policies that help to foster better relations and reject the aggressive stance taken by the United States.

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