This snapshot of Havana shows a healthcare system that is extensive, accessible and, at times, ropey. What is unique is the blend of third world conditions with a progressive ethos and first world results.
Michael Moore’s documentary, Sicko, holds up Cuba as a model. Whether it is a consultation, dentures or open-heart surgery, citizens are entitled to free treatment. As a result this impoverished Caribbean island has better health indicators than its much wealthier neighbour 144km across the Florida straits.
“There’s a reason Cubans live on average longer than we do,†Moore told Time magazine. “I’m not trumpeting [Fidel] Castro or his regime. I just want to say to fellow Americans, ‘C’mon, we’re the United States. If they can do this, we can do it.’â€
Other outsiders such as Kofi Annan, the former United Nations secretary general, a United Kingdom parliamentary select committee, and an array of NGOs have also lauded Cuban healthcare. Even some senior US officials, between bouts of Castro-bashing, have ceded some plaudits.
“Health and education are the revo-lution’s pillars of legitimacy so the government has to make them work,†says a senior Western diplomat in Havana. “If they don’t it loses all its moral authority. My sense is that the health system is quite good.â€
But how good, exactly? And how does Cuba do it given such limited means? Neither question is easy to answer. The communist government is not transparent, some statistics are questionable and citizens have reason to muffle complaints lest they be jailed as political dissidents.
According to the World Health Organisation, a Cuban man can expect to live to 75 and a woman to 79. The probability of a child dying aged under five is five per 1 000 live births. That is better than the US and on a par with the UK.
Yet these world-class results are delivered by a shoestring annual per capita health expenditure of $260 -- less than a 10th of Britain’s $3 065 and a fraction of the US’s $6 543.
There is no mystery about Cuba’s core strategy: prevention. From promoting exercise, hygiene and regular check-ups, the system is geared towards averting illnesses and treating them before they become advanced and costly.
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