Cuban health care: the ongoing revolution
by Don Fitz  Monthly Review Press £17.99

BY THE end of the 1980s, revolutionary Cuba had accomplished a great deal in medicine. At home it had expanded hospitals and clinics and integrated them into a unified healthcare system. It had created community polyclinics and a family doctor-and-nurse model in practice across the island.

Internationally Cuba had integrated military and medical interventions in Africa during the 1960s, hugely expanded its military and medical assistance in Angola, consolidated its medical internationalism with teaching, construction, forestry and other aid programmes, developed health education programmes in many countries, and brought large numbers of students to Cuba for education, especially medical education.

By 2000, Cuba had adjusted to the loss of Soviet support, maintained its healthcare system, protected the care of mothers and infants, weathered the HIV/Aids epidemic, continued health education, increased the scope of healthcare services for its people, matched the US for life expectancy, and surpassed it in reducing infant mortality.

In 1997 Chandler Burr wrote in the Lancet that Cuba had “the most successful national Aids programme in the world.” The UN stated that Cuba’s Aids programme was “among the most effective in the world.”

The economic crisis had not destroyed Cuba’s ability to provide for itself nor had the crisis undermined the Cuban people’s health.

Fitz writes: “The revolutionary rebound from the viciousness of the embargo showed that it had nudged Cuba toward what decades of Soviet tutelage failed to do: make the island more self-sufficient by diversifying its economy from a single export crop of sugar to one that included tourism and medical expertise as major sources of revenue.”

The progressive US economist Dean Baker suggested bringing down the high salaries of US medical professionals could be achieved by attracting more doctors from poor countries to practise medicine in the US. As Fitz rightly points out his would be the opposite of Cuba’s sending doctors abroad; it would exacerbate the “brain drain” of professionals from these countries and “further deprive impoverished people of necessary medical care.”

Fitz and Baker both understand that increasing the supply of doctors forces down their wages. Fitz, however, unlike Baker, understands that attracting more doctors from poor countries would worsen the health conditions of the peoples of those countries. Ghana has just one doctor for every 45,000 people. There are more Ethiopian doctors in Chicago than in Ethiopia.

Since 1961 over 124,000 Cuban health professionals have worked in over 145 countries. By 2008 Cuban doctors were providing medical care for over 70 million people in other countries. Cuban doctors in Venezuela helped to cut the infant mortality from 25 per 1,000 live births in 1990 to 13 in 2010.

By contrast, in 2017 Ecuador’s government accepted the IMF’s recommendation to slash the health budget by more than a third, leaving it without a decent health service and by December 2020, it had 3,768 deaths from Covid-19, compared to Cuba’s 136.

Another anathema to developing countries is the cost of medicines. The Trans-Pacific Partnership for example plans to extend the length of patent protection for pharmaceuticals to 12 years. That means cheaper, generic alternatives to brand-name drugs could not be sold, leaving millions of people in the member countries unable to afford critical medications.

Fitz concludes that all Cuba’s achievements would not have been possible in a capitalist economy — it owes its entire progress to being an independent socialist country.