Cuban socialism builds model health system

The 1959 Cuban Revolution overturned the U.S.-backed dictatorship of Fulgencio Batista. The revolution ended Cuba’s status as a U.S. neocolony and made possible a complete overhaul and rebuilding of the medical system in that country along socialist lines.

In 1960 revolutionary physician Che Guevara formally addressed the Cuban Militia. His speech has since been published as an essay titled “On Revolutionary Medicine,” which outlines the socialist view of the relationship between revolution, private property and medicine:

“For one to be a revolutionary doctor or to be a revolutionary at all, there must first be a revolution. Isolated individual endeavor, for all its purity of ideals, is of no use, and the desire to sacrifice an entire lifetime to the noblest of ideals serves no purpose if one works alone. ... The life of a single human being is worth a million times more than all the property of the richest man on earth. ... Far more important than a good remuneration is the pride of serving one’s neighbor. Much more definitive and much more lasting than all the gold that one can accumulate is the gratitude of a people.”

Pre-revolution statistics on the health and well-being of the Cuban people are scarce, as the average person’s welfare was not a priority for the dictatorship. The little bit that can be gleaned from Batista-era government records was communicated by former Cuban President Fidel Castro at a 1989 rally at Havana’s Plaza of the Revolution commemorating the 30th anniversary of the revolution.

At the time of the revolution Cuba’s infant mortality rate exceeded 60 deaths per 1,000 live births. Twelve mothers died during delivery for every 10,000 births. There were 6,000 doctors in the entire country, almost all of whom were concentrated in the capital. Life expectancy was below 60 years of age. Public health services were nonexistent in the countryside, where more than half the population lived.

Since that time Cuba’s health care system, which is 100 percent publicly owned, has developed into a pinnacle of achievement in socialist medicine. Article 50 of Cuba’s Constitution guarantees the right to health protection and care. The constitution provides for free medical and hospital care through a system of rural medical service networks, polyclinics, hospitals and treatment centers for preventative and specialized medicine. Free dental care, health education, regular medical examinations and general vaccinations are also guaranteed.

Cuba’s socialist system has made great advances in improving health quality. According to World Health Organization statistics published in 2009, Cuban life expectancy has increased to 78 years—18 years longer than the average Cuban could expect to live prior to the revolution and two years longer than the regional average for the Americas.

Cuba’s infant mortality rate has been reduced by more than 90 percent, to just five deaths per 1,000 live births. The average regional infant mortality rate is 16 deaths per 1,000. The maternal mortality rate has dropped to just over four deaths per 10,000 births. The decline in delivery-related deaths can be attributed to the fact that 100 percent of Cuban births are attended by skilled health workers. Today Cuba boasts more than 66,000 physicians and is able to send thousands of its own doctors to provide medical care to the world’s poor and oppressed.

“¡Salud!” a 2007 film highlighting Cuba’s health care accomplishments, estimates that this small country has approximately 28,000 health professionals now providing care in 68 countries. Cuban doctors and nurses serve the poorest of the poor in countries like Honduras, Haiti and Guatemala.

Tens of thousands of international students are studying free of charge in Cuba’s medical schools—on the condition that after graduation they provide care to underserved populations in their countries of origin.

These accomplishments fulfill the principles of socialist health care as laid out by Che in 1960. Much of Cuba’s success is a result of the socialist system’s integrated approach to care, which emphasizes health education, affordable housing, proper diet and other preventative measures designed to improve and prolong life.

Cuba is a developing country that has struggled with the loss of its biggest trading partner—the Soviet Union. The former socialist bloc, through the Council of Mutual Economic Assistance, had accounted for 85 percent of Cuban trade. More than 90 percent of Cuban energy needs had been met with Soviet oil and oil byproducts provided at subsidized prices.

With the 1991 defeat of the Soviet Union, the U.S. government saw an opening to attempt to strangle Cuba’s socialist system. In 1992 the U.S. Congress passed the so-called Cuban Democracy Act. The act is a vicious attack on Cuba’s health care system, which the World Health Organization had praised in 1989 as “a model for the world.”

A 1997 American Association of World Health report titled “Denial of Food and Medicine: The Impact of the U.S. Embargo on the Health and Nutrition in Cuba” outlines the difficulties deliberately imposed by the U.S. on Cuba’s health system.

The act imposed a ban on subsidiary trade with Cuba, severely constraining Cuba’s ability to import medicine and equipment from third-country sources. Shippers are discouraged from delivering medical equipment to Cuba by a provision in the act that prohibits ships from loading or unloading cargo in U.S. ports for 180 days after delivering cargo of any type to Cuba. Licensing and other restrictions restrain even charitable contributions to Cuba.

Despite the severe double blow dealt to the Cuban economy by the Soviet Union’s defeat and the punitive economic blockade by the U.S., Cuba has managed to protect the integrity of its health care system in a way that clearly illustrates the superiority of socialist health care.

Next: Clinton plan and right-wing scare tactics

• Part 1: The urgency of reform
• Part 2: Cold War politics forced Truman’s hand
• Part 3: Soviet medicine—a workers’ health plan
• Part 4: Radical movements create context for 1960s health care reform
• Part 5: Cuban socialism builds model health system
• Part 6: Attacks on Obama plan mirror Clinton health debate
• Part 7: Corporate giveaway in the name of reform
• Part 8: The impact of technology on health delivery and access
• Part 9: The road to health care justice