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Banned
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loquitur, according to this impressively impartial study, in 2003, Cuba experienced 39.5 maternal deaths per 100,000 births, almost twice the rate of death of black American mothers, and four times the rate of white Americans.....
The thing I wonder, and I should think you would want to wonder about too, is whether or not your political attitude towards Cuba is part of a collective influence that has the literal effect of killing people.
If your political prejudices are in actuality, an avoidable outcome of your political ideology, is there a political attitude that could be more treacherous or ignorant, expecially since it's practitioners consider themselves, almost unquestionably, to embrace "reasonable" political POV?
Quote:
http://ije.oxfordjournals.org/cgi/content/full/35/4/817
International Journal of Epidemiology 2006 35(4):817-824; doi:10.1093/ije/dyl175
Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2006; all rights reserved.
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Review
Health in Cuba
Richard S Cooper1,*, Joan F Kennelly2 and Pedro Orduñez-Garcia3
......Cuba's role in global health assistance
Given its limited economic resources, Cuba can only rarely afford direct aid.20 Instead it has adopted a strategy that relies on human resources. First targeted to Africa, the programme has now placed physicians, nurses, dentists, and other professionals in 52 countries.20,65,66 The most prominent episodes involved sending doctors to post-apartheid South Africa, providing long-term care for Chernobyl victims, and giving disaster aid to Central America after hurricane Mitch. Cuban personnel also staffed a new hospital in Gonaives, Haiti, which had been constructed with the Japanese aid; this facility was subsequently destroyed during the anti-Aristide strife in 2004 although the Cuban physicians have remained.67
To move from emergency assistance to a sustainable programme, a multicountry collaborative plan has recently been developed to improve health services in poor Latin American countries.66 A medical school was established in Havana in 1999 and more than 6000 students, primarily from Africa and Latin America, are currently being given a medical education at no expense.7,68,69 In the past 3 years more than 14 000 physicians and dentists have been placed in slums and rural communities in Venezuela as part of the new the partnership between Cuba and the Chavez government, and this number is set to rise to 20 000.68 Cuba has also agreed to educate 40 000 new physicians for Venezuela over the next several years.69
Cuba's medical assistance campaign has a number of dimensions. Like all foreign aid programmes, it assumes that some political benefits will be forthcoming in return. <h3>However, most of the countries that have been assisted, for example, Ethiopia, The Gambia, and Haiti, have nothing to offer in return. Unlike many donor programmes, placing physicians where none have practiced before has been overwhelmingly well received by the local communities.</h3>69 Thus, while the arrangement with Venezuela has direct economic benefit to Cuba, it has also transformed the health system by giving large segments of the Venezuelan population access to modern medical care.69
The special character of health sector development in Cuba can perhaps be best appreciated by considering the challenge any other society would face if it tried to send tens of thousands of physicians to live in slum communities in a foreign country for 2 years. While a range of incentives and motivating factors unique to the Cuban social context are operating, these assignments are accepted as a professional obligation by the vast majority of the Cuban practitioners and they perform effectively in the host communities. Much like the experience of military personnel on long tours of duty, the Cuban programme of assistance does nonetheless require extraordinary sacrifice and the hardship is not always borne lightly. Furthermore, the mobilization for assistance to Venezuela has meant that many Cuban neighbourhoods must share facilities. These sacrifices must, of course, be balanced against the conditions of desperate need in the communities on the receiving end. Many of these countries, particularly in Africa, have watched helplessly as the majority of their health professionals emigrate to the US and Europe.70 <h3>Offhand dismissal by observers in industrialized countries of the Cuban medical aid programme, which has such a powerful impact on these marginalized communities, is a clear indication of how perilously divided the discourse over global development has become.</h3>
Does Cuba's experience have broader significance?
The history of science is replete with stories of the delayed acceptance of unpopular or unfashionable ideas. The approach to improving global health taken by the donor community and academic medicine in rich countries is no exception. While criticisms of the basic approach are voiced—as in the recent assertion that the external measures of development have no meaning for the general population71,72—these critical voices have little influence on the practice of large international agencies. It is not the intent of this article, however, to summarize and make a judgment on economic assistance and progress in global public health. Instead, based on the weight of the evidence presented on the Cuban experience, we pose the following question: <h3>‘Why has the debate on solving the most urgent challenges in public health in poor countries ignored the experience of success?’ </h3>Traditionally, whether the experience is derived from randomized trials, high survival rates in clinical series, or favourable trends in vital statistics, biomedicine embraces the winner and seeks to imitate it. Precisely the opposite has happened in this instance.
There is, of course, no shortage of historical and ideological reasons why a debate on the ‘Cuban question’ has never reached maturity. Blind optimism is thought to have discredited the sympathetic scholarship about the Soviet Union, and to a lesser extent China, in an earlier era.73–75 Some observers are too concerned about putative restraints on civil liberties and the independent character of its foreign policy to develop any enthusiasm for the objectively more successful aspects of Cuban society. <h3>None of these concerns, however, undermine the force of the question, why have we ignored what works? </h3>
Before recommending components of the Cuban model for use in other settings, a thorough and balanced assessment of the strengths and weaknesses of those components would be required. That assessment would require a very different study of the health system's organization, capacity, and services. Our intent here is to demonstrate that sufficient cause exists to undertake that assessment. For an objective evaluation of the Cuban experience to succeed, an acceptance of certain ground rules would be required. First, this evaluation cannot be undertaken with the goal of winning a political argument. Although the trajectory of social development in Cuba over the past 50 years is both complex and controversial, as in all other countries, the public health experience should be subjected to judgment on the basis of the usual rules of science. Second, this judgment cannot be permanently postponed by skepticism about the validity of the data or concern over unrelated broader social questions. Ongoing, careful scrutiny of Cuban public health data is justified and to be welcomed; however, sufficient data now exist in several key areas to demonstrate that skepticism can no longer be the basis for a refusal to engage the question. Likewise, many societies embrace domestic and foreign policies that are questioned and even condemned by broad segments of the world community, yet the attempt to evaluate progress in improving the health of their populations is not thereby condemned as illegitimate or unnecessary. Third, the apparent successes recorded by Cuba should be seen as consequences of a well-defined strategy; the value of these underlying principles, not the accumulation of better numbers, is what holds implications for other poor countries, and not a few well-resourced societies.
Two aspects of the Cuban experience serve as reasonable demonstrations of the value of that strategic approach. In the area of infectious disease, for example, the operative principles are particularly straightforward: once a safe and effective vaccine becomes available the entire at-risk population is immunized; if a vaccine is not available, the susceptible population is screened and treated; where an arthropod vector can be identified, the transmission pathway is disrupted by mobilizing the local community which in turn requires effective neighbourhood organization and universal primary health care. The joint effect of these strategic activities will result in the elimination or control of virtually all serious epidemic infectious conditions. In terms of child survival, a ‘continuum of care’ that provides for the pre-conceptional health of women, prenatal care, skilled birth attendants, and a comprehensive well-baby programme can quickly reduce infant mortality to levels approaching the biological minimum. Many observers will regard these propositions as reasonable, yet hopelessly too ambitious for the poorer nations of the world. It must be recognized, however, that these principles have been successfully implemented in Cuba at a cost well within the reach of most middle-income countries.
Although other aspects of society, such as education and housing obviously make independent contributions to the success of public health campaigns, the Cuban strategy outlined here serves as a model that should be thoroughly evaluated. Needless to say, its implementation would face many challenges specific to the geography and politics of a region. Other models that dictate public health strategies face the same gamut of uncertainties and challenges, however, and none can be said to have met with similar success.76 The World Health Organization, for example, promulgated a set of principles in the Alma Ata ‘Health for All’ Declaration of 1978, many of which were incorporated into the Cuban approach.77 In recent years, however, international agencies have favoured privatization and reduction in state support for health systems.78 The record of achievement with privatized systems in poor countries has often been very limited.79 A debate which can use as a point of departure extensive empirical evidence of progress would provide a healthy reorientation in a discipline distracted by controversy and divided over political aims.
The health professions have little opportunity to intervene directly on historical events. However, in the conduct of our science we have both choice and responsibility. Challenging the acquiescence of the scientific community to ostracism of some of its members in an earlier era, Einstein remarked, ‘Political considerations, advanced with much solemnity, prevent... the purely objective ways of thinking without which our great aims must necessarily be frustrated’ [Ref. (80) p. 80]. <h3>If the accomplishments of Cuba could be reproduced across a broad range of poor and middle-income countries the health of the world's population would be transformed. This fact creates an obligation for health scientists.</h3> We should debate the merits of the principles embedded in the Cuban attempts to improve the health of populations.
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Last edited by host; 03-30-2008 at 01:37 PM..
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