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R2H in Cuba

R2H in Cuba. Pol De Vos pdevos@itg.be. From 1959 onwards. Cold War continued USA aggression long term USSR support Comprehensive revolutionary changes Housing Working conditions (radical land reform) Redistribution of income Health Education Culture and sports Defense.

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R2H in Cuba

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  1. R2Hin Cuba Pol De Vos pdevos@itg.be

  2. From 1959 onwards Cold War • continued USA aggression • long term USSR support Comprehensive revolutionary changes • Housing • Working conditions (radical land reform) • Redistribution of income • Health • Education • Culture and sports • Defense

  3. Consequences • All Cubans: decent wage, improved nutrition, housing • Electricity and tap water over the whole country • Inhuman working conditions disappear (landlordism) • Industrialization • Embargo and agressivity of USA • Support of Soviet Union • Alphabetization • Education • development of all educational levels • adult education: combination work & study • Expansion of culture, art, science and sports

  4. Production and distribution of wealth Human and social Development Production and distribution of wealth CUBAN REVOLUTION Political will Health as a human right and as a state policy Economic Socio-political Investment In social development Development of health system and services Participation Social networks Empowerment Management of human and social capital Inter-sectorial action promoted by state and directed by health sector ENVIRON MENT LIFE STYLES HUMAN BIOLOGY Health and well-being

  5. Cuba: health (care) for all 1960s – Ensure access to medical services for all 1970s – Community medicine 1980s – Family medicine Since 1990s – Reforms and adjustments Development of Cuban health system

  6. 1990s: Coping with economic crisis Economic and social measures : a participatory process • Taken step by step • After a broad consensus process (over > 3 years) • Discussions in neighborhoods and working places • Only broadly accepted proposals were put in practice • Implemented: • Legalization of US-Dollar • Selected joint-ventures (tourism, mining,…) • Peasant markets • Higher payments for telephone, gas, electricity • Not implemented • Introduction of tax-payment

  7. Cuba from 1990 onwards 8 965 FDrs 46.9 % coverage 27 169 FDrs 96.2% coverage 30 726 FDrs 99.2% coverage 37 645 FDrs INT COOP +++ Breakdown Soviet Union Torricelli act Helms-Burton Law 2010 1989 1995 2002 Unified public national health system maintained + Integrated system - Stability of F.Dr. in community + Free access - Lack of resources + Comprehensive care - Availability of drugs + Continuous care - Technology + Adequate health outcomes GDP – 35% Imports – 70 %

  8. Results of crisis management 1990s >< Venezuela (1989) – Ecuador (1997,2000,2005) – Argentina (2001) • Structural determinants remained priority, but eroded… • severe decline in living standards • deterioration of nutritional status • (limited) resurgence of (almost) eliminated diseases (tb) • vitamin deficiency -> epidemic neuropathy • Health system • Remains state priority • exclusively public (no privatizations) • Accessible, holistic, and integrated services of good quality • Free at the point of delivery • Central in limiting consequences of declining living standards

  9. After 2000 • Continued economic strain • US enmity and embargo remains • Alliance with Bolivarian Venezuela • Intensive collaboration in health • Oil • Industrial collaboration • 2011: new economic measures • Decreasing role of de state • Increasing disparities in income (dual currency) • Health system maintained but under strain

  10. Health system today Health Area (30.000 inh) policlinic Family Doctor 1000-1500 inh referral hospital • Cuban national health system • exclusively public • free at point of delivery • FLHS: Family Dr = entry point • well-defined population of responsibility • holistic and integrated approach

  11. International Cooperation in health • 40.000 Cuban professionals are working in 105 countries • 80% (+ 30 000) work in the health sector in 68 different countries • Cuba trains medical students from many of thepoorest regions to serve their communities • Actually 35 out of 54 African countries have medical students being trained in Cuba • Important support in health care delivery in many countries • limitations to overcome (integration)

  12. Emergency Aid: Brigade Henry Reeve Katrina – 2005 – New Orleans

  13. International health policy debate • Cuba = one of the few important international health players that actively oppose neo-liberal privatization and profit in health services • Defends development of accessible, qualitative and responsive public health services • counterexample of idea that “public services can’t function” • important example to defend “public rationale” in other contexts

  14. DL1 • 14.30-17.00 hrs • Empowerment • Centro Habana, Cuba: “Empowerment through multisectorial action”

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