Sunday, May 23, 2010

"opportunities to learn from Cuba"

[deutsche Version]

The US trade embargo against Cuba is turning 50 this year, and one should hope that after half a century of watching this policy fail to achieve its goals, even the most blockheaded lobbyists should start to scratch their heads and have a good re-think. But then again, one should have hoped that, too, after a whole century of catastrophic failure in the “war on drugs.”

Anyhow, very subtle signals seem to indicate that the US are slowly but surely beginning to move on this issue. Among the signals is the recent publication of a “Policy Forum” piece by Paul Drain and Michele Barry in Science magazine (vol 328, p 572, 30.4.2010), analysing the effect of the embargo on public health in Cuba and the reasons why Cuba’s health system has been spectacularly successful in spite of it.

One particularly insidious part of the story, I learned from the Science piece, is the “Torricelli Bill” of 1992, which suppressed the export of medical supplies to Cuba and did have a measurable impact on public health in the country. (I really can’t get my head round this – the lobbyists in Miami must have been twisting lots of people’s arms to ensure that their relatives back home don’t get medical supplies when they need them. Does anybody understand this?) Apart from the blip following that law, however, life expectancy in Cuba has risen steeply in the 50 years since the embargo began, and has drawn equal with the US, even though health spending in Cuba is by orders of magnitude less than in the US. It is tempting to cast a cynical eye at the data and conclude that the Torricelli Bill was a desperate attempt to stop Cuba from overtaking the US on health indicators such as life expectancy, and as such it has, just about, worked.

But how could Cuba achieve what has been described as “developed world outcomes at developing world prices”? The article highlights the Cuban emphasis on disease prevention and primary health care. Educating people about health risks is relatively cheap. Letting them run the risk and then trying to cure the diseases with pharmaceuticals, as done in the US, is much more expensive. In terms of access to primary medical care, Cuba has a very large number of physicians per capita, and even in remote rural areas, access to medical care isn’t much of a problem. And, unlike the UK’s NHS, they do believe in checkups. Every Cuban citizen, I learned, is expected to see a physician at least once a year.

Disease prevention also depends on vaccination programs, which in turn depend on the manufacturing and indeed invention of affordable vaccines. When I visited Cuba in 2004, I was fortunate to catch the story of the new, affordable HiB vaccine developed at Havana just before this advance was published in Science. This was an outstanding success, but more generally, the biomedical research institutes in Havana are widely recognised for their world-class research, which directly leads to effective and affordable vaccinations for the Cuban people.

Sensationally for a publication that is kind of a flag carrier for US science, the article concludes that in the wake of the US healthcare reform “there may be opportunities to learn from Cuba valuable lessons about developing a truly universal health care system that emphasizes primary care. Adopting some of Cuba’s successful health-care policies may be the best first step toward normalizing relations.”

Call me crazy, but I am feeling cautiously optimistic that the embargo madness won’t last for another 50 years.

Paul K. Drain and Michele Barry
Global Health:
Fifty Years of U.S. Embargo: Cuba's Health Outcomes and Lessons
Science 30 April 2010:
Vol. 328. no. 5978, pp. 572 - 573
DOI: 10.1126/science.1189680
summary and access to PDF file (PDF access may be restricted, not sure)

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