But in very serious ways Cuba shows what can be done, even when undermined by a powerful neighbour and when poor, if one has the right priorities. Freedom from illness is a very important freedom. Many in the US would envy Cubans' access to health care - cf. Moore's F 9/11 sequence on taking sick Americans to Cuba for treatment.
When the Macroeconomic Commission on Health met to consider the global health challenge it essentially did little more than recommend implementation of Essential Health Interventions, a more systematic way to provide the quasi-technical solutions that `Selective Primary Health Care' had promised. And yet, while this was occurring, Cuba was able to develop a set of coherent policies to adopt a national strategy, develop a comprehensive primary care capacity, and achieve excellent health outcomes. Some time ago, it was suggested that the threat of a good example (or a politically alternative development trajectory) was an ideological factor in explaining why US policy was uncompromisingly hostile to Cuba.9 The openness to consider Cuba's achievements is clearly called for now, and the taboo on evaluating this experience should be lifted. The question ultimately should then become less of `whether' and `why' the successes are being achieved and more of `how' this can be done. Over the past 10 years, our team of Canadian and Cuban researchers has documented how it is not just the organization of health services but the broad way in which health determinants are addressed that plays a major factor in the `social production of health'--with the possibility of fruitfully engaging the health service workforce as part of a broad-based `population health team.'10,11 http://ije.oxfordjournals.org/cgi/content/full/35/4/825
When the Macroeconomic Commission on Health met to consider the global health challenge it essentially did little more than recommend implementation of Essential Health Interventions, a more systematic way to provide the quasi-technical solutions that `Selective Primary Health Care' had promised. And yet, while this was occurring, Cuba was able to develop a set of coherent policies to adopt a national strategy, develop a comprehensive primary care capacity, and achieve excellent health outcomes.
Some time ago, it was suggested that the threat of a good example (or a politically alternative development trajectory) was an ideological factor in explaining why US policy was uncompromisingly hostile to Cuba.9 The openness to consider Cuba's achievements is clearly called for now, and the taboo on evaluating this experience should be lifted. The question ultimately should then become less of `whether' and `why' the successes are being achieved and more of `how' this can be done. Over the past 10 years, our team of Canadian and Cuban researchers has documented how it is not just the organization of health services but the broad way in which health determinants are addressed that plays a major factor in the `social production of health'--with the possibility of fruitfully engaging the health service workforce as part of a broad-based `population health team.'10,11
http://ije.oxfordjournals.org/cgi/content/full/35/4/825
And that aside, I wouldn't put too much credit on a photo-op. The Cuban propagandists aren't any dumber than American propagandists, and I'm sure that if you took a band of Cubans to the US for a film shoot about how awful the Cuban system is, someone in the US would come up with excellent care for them for a very modest sum.
- Jake If you only spend 20 minutes of the rest of your life on economics, go spend them here.
More significant was the article I quoted from. In terms of health-care for the whole population, Cuba is indeed a threatening "good example" for US "health" corporations. See also a WHO report:
"We fought for the Declaration of Alma-Ata before it was official," says Dr Cristina Luna, "and its message has guided and challenged us ever since." At 43, Luna is Cuba's national director of ambulatory care, and on her shoulders rests the country's entire primary health care system, by many standards one of the world's most effective and unique. Cuban health authorities give large credit for the country's impressive health indicators to the preventive, primary-care emphasis pursued for the last four decades. These indicators - which are close or equal to those in developed countries - speak for themselves. For example, in 2004, there were seven deaths for every 1000 children aged less than five years - a decrease from 46 such deaths 40 years earlier, according to WHO. Meanwhile Cubans have one of the world's highest life expectancies of 77 years. http://www.who.int/bulletin/volumes/86/5/08-030508/en/index.html
Cuban health authorities give large credit for the country's impressive health indicators to the preventive, primary-care emphasis pursued for the last four decades. These indicators - which are close or equal to those in developed countries - speak for themselves. For example, in 2004, there were seven deaths for every 1000 children aged less than five years - a decrease from 46 such deaths 40 years earlier, according to WHO. Meanwhile Cubans have one of the world's highest life expectancies of 77 years.
http://www.who.int/bulletin/volumes/86/5/08-030508/en/index.html
Cf.Krgman on "socialized medicine":
The dissonance ... is one reason the Medicare drug legislation looks as if someone went down a checklist of things the veterans' system does right, and in each case did the opposite. For example, the V.H.A. avoids dealing with insurance companies; the drug bill shoehorns insurance companies into the program... The V.H.A. bargains effectively on drug prices; the drug bill forbids Medicare from doing the same. Still, ideology can't hold out against reality forever. Cries of "socialized medicine" didn't, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush's unrealistic vision of a system in which people go "comparative shopping" for medical care the way they do when buying tile, represents the true future of American health care. http://economistsview.typepad.com/economistsview/2006/01/paul_krugman_he.html
The dissonance ... is one reason the Medicare drug legislation looks as if someone went down a checklist of things the veterans' system does right, and in each case did the opposite. For example, the V.H.A. avoids dealing with insurance companies; the drug bill shoehorns insurance companies into the program... The V.H.A. bargains effectively on drug prices; the drug bill forbids Medicare from doing the same.
Still, ideology can't hold out against reality forever. Cries of "socialized medicine" didn't, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush's unrealistic vision of a system in which people go "comparative shopping" for medical care the way they do when buying tile, represents the true future of American health care.
http://economistsview.typepad.com/economistsview/2006/01/paul_krugman_he.html
Thank you for outlining your position. I understand that you have sympathy for victims of US aggressions.
OTOH I don't think that the evil done unto them makes them automatically good, or rather -
Have you ever lived in a communist country? I haven't but I sort-of have, too, since Germany has had experience with both. - I visited East Germany twice with the wall still there, and twice when it had just come down. I didn't like it. People who lived there didn't like it, and why did the system collapse to begin with?
I have a friend you lives in England, and I know of the dire state British health care is in. I understand that it is tempting to admire Cuba's "freedom of health" in comparison. But that still doesn't make of it a "good example".
Eastern Germans are less satisfied with and less optimistic about their situation than those living in the states that made up the former West Germany. They are also less convinced about the virtues of democracy than their western counterparts -- with many believing that socialism is a good idea that just hasn't been implemented well in the past. Indeed, the biggest differences in the survey come when eastern and western respondents are asked to share their views on life in the former East Germany. The communist state gets far higher marks from those living in the east than from those in the west. A full 92 percent of 35- to 50-year-old eastern Germans believe that one of the greatest attributes of the former East Germany was its social safety net, with 47 percent of their children in the east believing the same thing. By contrast, only 26 percent of western youth and 48 percent of their parents expressed the view that East Germany had a strong social welfare system compared to today's. http://www.spiegel.de/international/germany/0,1518,516472,00.html
Indeed, the biggest differences in the survey come when eastern and western respondents are asked to share their views on life in the former East Germany. The communist state gets far higher marks from those living in the east than from those in the west. A full 92 percent of 35- to 50-year-old eastern Germans believe that one of the greatest attributes of the former East Germany was its social safety net, with 47 percent of their children in the east believing the same thing. By contrast, only 26 percent of western youth and 48 percent of their parents expressed the view that East Germany had a strong social welfare system compared to today's.
http://www.spiegel.de/international/germany/0,1518,516472,00.html
Of course there are problems with the UK health service (as there are even with the French system), partly due to underfunding for years and wasting billions on things like Trident. But in general it is very popular. The US system which leaves millions with no health insurance, and many with problems getting their claims paid. Cf. Krugman's "Conscience of a Liberal" for a serious discussion, and Moore's "Sicko" for a dramatic comparison. Maybe it's because I'm a Londoner - that I moved to Nice.
