“A lo Cubano” The Evolution of the Cuban Health System and the Implications of a Revolutionary Promise of Health for All

Abstract

The 1959 Revolution added the principles of state responsibility and universal access to an already vibrant health ideology and social conception of medicine in Cuba. The evolution of the new Ministry of Public Health and the National Health System led to continued revising and additions to the revolutionary promise of health. Furthermore, the economic devastation of the 1990s induced by the fall of the Soviet Union, the collapse of the Soviet trading bloc CMEA, and a tightening of the US embargo, ushered in a new era for the revolutionary promise of health. Since 1989, severe material scarcity and infrastructure deterioration have threatened the continued application of the core principles of Cuban health ideology. Through it all, Castro maintained an unwavering commitment to delivering on the promises of the Revolution. Beyond improving the health status and wellbeing of the Cuban people, the revolutionary promise of health has served as a legitimizing force for the socialist government and an achievement worthy of international recognition. Even Castro’s harshest critics cannot dismiss the drastic health indicator improvements and reductions in disparities Cuba has experienced in the five decades since the Revolution. In its first three decades, the revolutionary promise of health evolved to include seven principles, four of which were developed years after the Revolution ended but became integral parts of the health system. The seven principles are as follows: (1) state responsibility over health and healthcare, (2) free and universal access, (3) equity in distribution and quality of care, (4) integration of preventive and curative medicine, (5) integration of health education and promotion, (6) popular participation in community health, (7) international medical cooperation. During the Special Period of the 1990s, the Cuban health system struggled to maintain the health indicators it had achieved through 30 years of innovative reform. Severe material scarcity troubled the system as it coped with the deteriorating health of the Cuban people. Specific issues arising from the embargo and the crisis were ameliorated through targeted programs and development of domestic production capabilities; however, it became evident by the end of the decade that health inequality, or at least socioeconomic inequality, had risen in Cuba. Since the beginning of the Special Period, however, chronic shortages and infrastructure deterioration have lowered the level and quality of care that the Cuban Health System can provide. This development has coincided with an increase in income inequality from unequal access to convertibles (US dollar equivalent) to create an underground market for health. Nobody denies the deep social and economic problems facing Cuba today. Five decades of a planned economy, low labor productivity, dependence on foreign imports, a crippling US embargo, and countless recessions due to global fluctuations in the price of sugar have surely worn down the island nation. One aspect of the Revolution that has not changed since 1959 is the government’s emphatic commitment to investing in the strongest resource any sovereign nation could invest in: its people.