Healthcare in Cuba - History

History

As was true of the other indigenous societies of the Americas, Cuban traditional medicine existed before the Spanish conquest. High-status traditional practitioners were called Bohiques. After colonization by the Spanish, Cuban medicine followed the Spanish tradition which was inherited from the Moors (which in derived from the Greeks/Romans and Ancient Egyptians). Chinese medicine has also been practiced in Cuba; its most famous practitioner was the 19th century doctor Cham Bom Biam or “El Medico Chino”.

Modern Western medicine has been practiced in Cuba by formally trained doctors since at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world class doctors, including Carlos Finlay, whose mosquito-based theory of yellow fever transmission was given its final proof under the direction of Walter Reed, James Carroll, and Aristides Agramonte. During the period of U.S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass and surgeon Jesse William Lazear.

By the 1950s, the island had some of the most positive health indices in the Americas, not far behind the United States and Canada. Cuba was one of the leaders in terms of life expectancy, and the number of doctors per thousand of the population ranked above Britain, France and Holland. In Latin America it ranked in third place after Uruguay and Argentina. There remained marked inequalities however. Most of Cuba's doctors were based in the relatively prosperous cities and regional towns, and conditions in rural areas, notably Oriente, were significantly worse. Only 8% of the rural population had access to healthcare. The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.

Following the Revolution and the subsequent United States embargo against Cuba, an increase in disease and infant mortality worsened in the 1960s. The new Cuban government asserted that universal healthcare was to become a priority of state planning. In 1960 revolutionary and physician Che Guevara outlined his aims for the future of Cuban healthcare in an essay entitled On Revolutionary Medicine, stating: "The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices." These aims were hampered almost immediately by an exodus of almost half of Cuba’s physicians to the United States, leaving the country with only 3,000 doctors and 16 professors in the University of Havana’s medical college. Beginning in 1960, the Ministry of Public Health began a program of nationalization and regionalization of medical services.

In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states "Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All the population cooperates in these activities and plans through the social and mass organizations."

Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9.2 doctors per 10,000 inhabitants in 1958, to 58.2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal vaccinations. This helped eradicate many contagious diseases including polio and rubella, though some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis, hepatitis and chicken pox. Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care.