In January 2014, the President of the Board of Directors of One World One Community (OWOC), Archbishop Athenagoras of the Orthodox Archdiocese of Mexico, invited me to accompany him to La Habana, Cuba for my first visit. The occasion was the 10th anniversary of the consecration of St. Nicholas Church in old Havana. The Church resides on a UNESCO World Heritage Site, a gift from the Cuban government. It is a proud building, appointed by the finest handcrafted furnishings straight from Greece. This opportunity, among other experiences throughout my time working in conjunction with His Eminence, has afforded me the opportunity to witness first-hand the enormous benefit the Cubans have enjoyed from their medical system. I have also found that the Cuban people have a deep love for the United States, a strong bond between one another, and a healthy population due to their exceptional medical system.
Here at home, much has been said — and much, likely, will continue to be said — about Cuba in the coming months. Whether it be about lifting the embargo, resolution of political tensions with the United States, immigration, classic cars, economic opportunity or any other topic surrounding the island state. One less obvious topic is Cuba’s exceptional healthcare system at home and its distribution of doctors to humanitarian crises around the globe. Cuba has a strong, effective focus on preventative medicine, which traces its roots back to the 1960s with the creation of el servicio médical rural (the Rural Medical Service) which enlisted 750 doctors committed to revitalizing healthcare networks for the poor and those far from urban centers.
The Cuban example illustrates the positive net effect of a focus on prevention and locally-tailored solutions that are based on the needs of the communities’ served. Rather than spending the bulk of the available healthcare dollars and energy fighting diseases and problems with expensive clinical services once someone is already sick, it is a mechanism designed for defeating the cause of disease and treating it fundamentally before it becomes complex.
The design logic is simple: Try to fix the problem early and at its roots, rather than fight to alleviate or lighten the secondary symptoms later on. This allows for a more replicable, teachable, easy-to-navigate system of healthcare where people young and old are taught best practices for their health, rather than treat maladies as they arise.
A good case-in-point was Cuba’s response to an outbreak of Dengue Fever in the 90s. Not only did the Cuban government send in doctors to treat the sick and handle the after effects of the disease, they proactively launched a concerted campaign to eliminate standing water in homes in an attempt to curb the local mosquito populations to prevent the bugs from being able to breed, thereby minimizing potential new sources of the disease in the future.
In a similar vein, Cuba is unwavering in its commitment to community medical care across the entire country. There’s certainly a dispute or two regarding central planning, but it has allowed Cuba to place doctors even in rural and out-of-reach places throughout the island, nearly 33,000 family physicians in total. This gives the Cuban healthcare system incredible flexibility to respond to local needs because it has, far and away, the most doctors-per-person of anywhere in the world, ready to respond to local problems wherever they arise.
This structure allows local physicians to not only mandate annual check-ups for the patients in their community. It even enables physician’s to go visit patients in their homes if they skip out or are unable to attend. This prevents chronic (and often treatable) diseases, such as high blood pressure, from blowing up into severe, lifelong problems by catching them early and nipping them in the bud before they get out of control. Unsurprisingly, Cuba is among the world’s leaders in childhood immunization across a broad swath of diseases, including diseases such as measles that even the United States fails to effectively deal with in many cases.
Complimenting their impressive healthcare apparatus, Cuba boasts high literacy and education rates. This helps to promote and support the national priority on medical care (especially for children) despite competing concerns, such as the economy. These, as well as other factors, help make Cuba’s national health ratings largely divergent from conventional health expectations based on economic well-being.
The results are not only effective medically — with remarkable life-expectancies (76-81 years, on par with the United States and Europe), infant mortality rates (again, on par or above many developed nations), and deaths under the age of five (you guessed it) — but they are economically efficient, perhaps even critical.
The dollar figures are jarring and oft-reported – Cuba spends roughly $300 dollars per person per year on medical attention, even taking into account the subsidies and taxes that make Cuban healthcare “free” for the entire population. This is a far cry from the United States, where the bill is nearly 30 times as much per person. Much evidence exists to support the notion that, across the physical and socioeconomic landscape of the U.S., the existing medical mechanism still leaves much to be desired for many.
And in case you were wondering if, somehow, the dollar figures aren’t related to Cuba’s healthcare design, think again. The World Health Organization (WHO) asserts that Cuba’s approach, specifically its extensive access to healthcare throughout the country, is closely linked to its status as a “high performer” when measuring the economic efficiency of healthcare performance. The WHO study concludes that the Cuban flavor of healthcare exemplifies the “key determinants of a well-functioning or high-performing health system” despite Cuba’s relative economic afflictions. The end-result is a healthcare system that consistently delivers impressive performance across a variety of indices despite operating on a shoestring budget.
This outcome, given Cuba’s focus on prevention, makes sense because curative medicine is much more expensive by any measure than preventative medicine. This clearly stems from Cuba’s focus on universal and non-invasive measures. The United States, which spends far more heavily on curative care, provides a stark contrast in approach and results. The idiom “an ounce of prevention is worth a pound of cure” is certainly borne out in Cuba. It may be more accurately described as being worth exponentially more, reflected both in the exceptional accomplishment in the doctor’s office and the money left in the patient’s wallet.
Taken together, these factors together lead the World Health Organization to call Cuba’s approach a model to be repeated and mimicked by other low-income countries, both in Latin America and in other parts of the world, to create highly-effective healthcare systems despite limited resources.
For its part, Cuba is striving to do just that. Cuba has trained over 23,000 doctors (and is sending out thousands more by the year) through their Latin American Medical School (ELAM, or Escuela Latinoamericana de Medicina) to help share the benefits of the Cuban system throughout the world. ELAM focuses on attracting future doctors from all over the world, training them at one of Cuba’s top-flight medical schools, and sending them to underserved and underdeveloped countries.
And the kick?
The whole process is free of charge for the students. After getting an education, these newly-minted doctors not only treat patients but are the lifeblood for shaping better, more universal, more sustainable healthcare systems on the ground where these systems are needed most, a formula that is already paying dividends for host countries.
There remain lasting, material differences between the situation Cuba finds itself in compared to that of the United States, and we can count ourselves fortunate for that. But it bears pointing out that Cuba has had incredible, effective results, and is using them to reshape how developing countries tackle critical healthcare concerns in a world of economic constraint.
Maxwell D. Dotson, Huffington Post
April 17, 2015