Cuban healthcare is often touted as something unique. The country has implemented high-quality universal and completely free healthcare, functioning even in the face of an economic blockade that has cost the state over one hundred billion dollars. What does this legendary medical care look like, and how much truth is there in its uniqueness?
History
Cuban medicine—contrary to a certain propaganda model created by Cuba's supporters—did not start from scratch right after the 1959 revolution. Between the 19th and 20th centuries, Carlos Finlay, a pioneer in yellow fever research, made a significant contribution to Cuban medicine and is now one of the country's icons. Under Batista's dictatorship, healthcare developed, but its elitist character remained a problem—it mainly served the wealthiest, often excluding villages and poorer regions.
True universality and revolutionary character came only with the overthrow of the pro-American dictatorship by the 26th of July Movement. Ernesto "Che" Guevara, a doctor by training, placed great emphasis on the priority development of public healthcare to serve not only citizens but also residents of poorer Third World countries. In the following years, reforms were implemented that constitutionally guaranteed every Cuban the right to completely free medical care, free dental care, and a universal vaccination program. According to Father Frei Betto, Fidel Castro was very absorbed in medical technology innovations, which led him to spend hours reading reports on each such innovation to subsequently implement them.
Data and Statistics
The effectiveness of healthcare is best illustrated by current data on the country1:
- Life expectancy is 78.6 years, which is a very good result, slightly lower than in the USA (79.8 years).
- Infant mortality in Cuba is extremely low; according to the latest data, it is about 4.5 deaths per 1000 live births, which is a better result than in the USA (4.7 per 1000).
- During the coronavirus pandemic, the mortality rate in Cuba was 75.31 per 100,000 inhabitants, which was one of the lowest rates in all of Latin America.
Of course, context is important here. Countries like Poland, the Czech Republic, or Germany surpass Cuba in most of the rankings mentioned here, but it should be remembered that we are talking about a small, island state of the Third World, held back by decades of colonialism, hostile destabilization, sanctions, and embargoes. With this in mind, Cuba, in a sense, undermines the liberal dogma about the efficiency of healthcare privatization, showing that state care can function well even in such unfavorable circumstances.
Development and Medical Science
Cuba is home to one of the largest medical schools in the world—the so-called ELAM (Latin American School of Medicine), training students from all over the world, including Europe and the USA2. There are 94.3 doctors per 10,000 inhabitants, which is a higher rate than in the UK or the USA. Students do not have to worry about accommodation, tuition, or food, as the school provides everything, including scholarships.
The biotechnology sector has been developed to such an extent that as early as the beginning of the 1990s, the Caribbean island found itself among the world leaders in this industry. BioCubaFarma, a state biotechnology concern, despite material and staff shortages, can boast significant achievements and about 2438 patents registered abroad3. Its effectiveness is illustrated by the fact that thanks to its work, Cuba in 2015 became the first country in the world certified by the WHO for eliminating the transmission of the HIV virus from mother to child. In addition, cardiovascular tests, lung cancer vaccines, and a diabetic foot drug have been developed there. During the COVID-19 pandemic, a series of vaccines with over 90% effectiveness were even developed.
International Aid
Cuba is also a world leader in providing medical assistance and education to countries of the Global South. Cuban doctors often volunteer to work abroad in crisis situations, for example, in Venezuela or Ecuador. It is worth mentioning the medics who played a key role in combating the Ebola virus in African countries—Cuba sent 165 doctors to Sierra Leone alone4. During the coronavirus pandemic, when the systems of many richer countries were failing, the government in Havana sent 52 experienced medics to the epicenter of the pandemic in northern Italy, whom the local media dubbed the "white army."
Allegations
A serious problem is the shortage of basic medicines, equipment, and medical supplies, which is a result of the embargo5. Propaganda often tries to blame the system itself for these shortages. Meanwhile, American restrictions on the sovereign Cuban state are not only a tragedy for its inhabitants but also affect the rest of the world. If Cuba had free access to materials and international cooperation, many ailments plaguing humanity could be more effectively combated, and progress in medicine would not be artificially slowed down by the reluctance of one country.
Another point of criticism is the low salaries of Cuban doctors. This is an important issue, although it should be taken into account that the salary situation in this profession worsened after the fall of the Eastern Bloc and, at the same time, due to the deteriorating economic situation of the country, artificially weakened by American sanctions.
Healthcare for Everyone?
Another allegation is the existence of a so-called "two-tier health system," where "medical tourists" paying in dollars receive higher quality care than ordinary Cubans. This is evident, for example, in the use of better equipment and a wider range of medicines in clinics such as Cira Garcia, which Cuban residents often cannot access. This pathology was pointed out, among others, by the former Cuban neurologist Hilda Molina, who openly described such practices as undermining the idea of the revolution, which was supposed to provide completely free and high-quality healthcare for all.
Although it cannot be denied that this procedure brings Cuba closer to the capitalist model, it should be remembered that it is also a derivative of the country's main problem. Income from medical tourism, estimated at about 20 million dollars annually, is a huge cash injection into the state budget, allowing the maintenance of universally free healthcare for citizens. The crisis of the 1990s, associated with the fall of the key trading partner—the USSR, forced the Cuban system to introduce reforms that would prevent the complete collapse of the healthcare program. Although morally dubious, these solutions are currently necessary for the survival of the system.
Summary
Cuban healthcare has been appreciated by international opinion to such an extent that even the British House of Commons Health Committee recognized it as a success. The former director of the World Health Organization, Margaret Chan, recommended that other countries follow Cuba's example. This best illustrates that although Cuba faces serious problems, it remains at the forefront of medicine among less developed countries and even surpasses the richest world powers in some areas, which—despite their wealth—are not always able to provide their citizens with what poor and externally devastated Cuba offers.
