Reducing disparity in human healthiness

Cuba is a "third world" country, with limited economic resources. However its demographic profile has come to resemble that of highly industrial countries more than "third world" nations. Average life expectancy rose from fifty-nine years before the revolution to seventy-six years in 1992, exceptional even by industrial Western and former Eastern European-bloc standards. Infant mortality dropped from 36 per 1,000 live births before the revolution to 8 in 1996, and with nearly 100 percent of all babies born in hospitals, staff were on hand to attend to any birth-related problems. Maternal mortality stood in 1996 at 2.4 per 10,000 births – barely above North American rates. This is the result of policy priorities evident from the early days of the 1959 revolution to grant all Cubans, urban or rural, similar standards of health care.

The structure emphasizes grassroots delivery of health services: the administration of health is centralized while the delivery of services is decentralized. A well-organized system of health centers, known as polyclinics, provide ambulatory care throughout the country. The polyclinic-based system delivers a fairly standard set of services and aimed at universal coverage within territorially defined districts. Doctors and support staff are given responsibility for a given group of families within their assigned district.

In the context of Latin America, Castro's Cuba alone offered a universal, institutionalized system of free rural and urban health care. In the capitalist countries in the region, public and private medical facilities remain more doctor-oriented, more concentrated in the major cities, and less accessible to the masses, and government-subsidized health care is available, in the main, only to the fraction of the labor force who work for the state or formal-sector private firms. Also, the diversity of Cuba's health care offerings are exceptional by regional and Third World standards: the high-tech along with low-tech curative and preventive care.

The Cuban system has come under enormous strain, as with all other aspects of Cuban society and infrastructure, in the decade following the collapse of the country's former patron, the Soviet Union. But these health gains have largely been preserved, and even improved. Globalizing Cuba's grassroots approach would mean training some 850,000 health workers, according to UNICEF and World Health Organization reports, as well as the necessary drugs and equipment. The total cost would be US $200 million, about the price of half a dozen jet fighters.