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Health in Cuba refers to the overall health of the population of Cuba. Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991; the stepping up of the US embargo against Cuba at this time also had an effect.
In 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 life expectancy, and the number of doctors per thousand of the population ranked above Britain, France and the Netherlands. In Latin America it ranked in third place after Uruguay and Argentina. [1] 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. [2] The mortality rate was the third lowest in the world. [3] According to the World Health Organization, the island had the lowest infant mortality rate of Latin America. [3]
Following the Revolution and the subsequent United States embargo against Cuba, an increase in disease and infant mortality worsened in the 1960s. [4] The new Cuban government asserted that universal healthcare was to become a priority of state planning. In 1960 guerrilla leader 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." [5]
The loss of Soviet subsidies brought food shortages to Cuba in the early 1990s.
A Canadian Medical Association Journal paper states that "The famine in Cuba during the Special Period was caused by political and economic factors similar to the ones that caused a famine in North Korea in the mid-1990s. Both countries were run by authoritarian regimes that denied ordinary people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military." [6] The regime did not accept donations of food, medicines and money from the US until 1993. [6] Malnutrition created epidemics. [7]
| Life expectancy at birth m/f: | 77/81 (years, 2016) |
| Healthy life expectancy at birth m/f: | 67.1/69.5 (years) |
| Child mortality m/f: | 5 (per 1000 live births, 2018) |
| Adult mortality m/f: | 116/68 (per 1000 population, 2016) |
| Total health expenditure per capita: | 2475 (Intl $, 2014) |
| Total health expenditure as % of GDP: | 11.1 (2014) |
| Rank | Countries surveyed | Statistic | Date of Information | |
|---|---|---|---|---|
| 125 | 167 | HIV/AIDS adult prevalence rate | 0.10% | 2003 est. |
| 162 | 175 | Fertility rate | 1.66 (children/woman) | 2006. |
| 153 | 224 | Birth rate | 11.89 (births/1,000 population) | 2006 est. |
| 168 | 226 | Infant mortality rate | 6.04 (deaths/1,000 live births) | 2006. |
| 129 | 224 | Death rate | 6.33 (deaths/1,000 population) | 2005. |
| 37 | 225 | Life expectancy at birth | 77.23 (years) | 2006. est |
| 17 | 99 | Suicide rate | 18.3 per 100,000 people per year | 1996.* |
Life expectancy at birth in Cuba in 1955 was 63 years [8] in 1960 it was 63.9 years. [9] To put these values in context, life expectancy at birth in some other regions and countries in 1960 were: (World Bank data):
World, 50.18 years; Latin America and Caribbean, 56.21 years; high-income OECD countries, 69.01 years; United States, 69.77 years. [10]
In 2007, the life expectancies at birth were as follows (World Bank data): Cuba, 78.26 years;
World, 68.76 years; Latin America and Caribbean, 73.13 years; high income OECD countries, 79.66 years; United States, 77.99 years. [11]
The mortality rate for children under five years old was 54 per 1000 in Cuba in 1960 (World Bank). [12] That year in Latin America and the Caribbean it was 154.66 per 1000; in the high-income OECD countries it was 43.11; in the United States, 30.2. No World datum is available for 1960, but for 1970 it was 145.67 per 1000 (World Bank data). [11]
The mortality rates for children under five in 2007 were as follows (World Bank): Cuba, 6.5; World, 68.01; Latin America and Caribbean, 26.37; high-income OECD, 5.71; United States, 7.60. [11]
Infant mortality was 32 per 1000 live births in Cuba in 1957. [13] In 2000–2005 it was 6.1 per 1000 in Cuba; and, for comparison, 6.8 per 1000 in the United States. [14] The 2007 infant mortality rates published by the World Health Organization in 2009 were: Cuba, 5; World, 46;
High income countries, 6; United States, 6. [15]
The table below shows CEPAL (United nations) data spanning the pre- and post-revolutionary periods for three public health indicators. Health levels were better than the Latin American average before the revolution and showed continued steady improvement throughout the post-revolutionary period. The total mortality rate shown is the crude – i.e., not age-adjusted – rate, and therefore tends to rise as the proportion of elderly people in the population increases, which has been the case in Cuba because the birth rate is falling and life expectancy is rising.
| 1950–55 | 1955–60 | 1960–65 | 1965–70 | 1970–75 | 1975–80 | 1980–85 | 1985–90 | 1990–95 | 1995–00 | 2000–05 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Life expectancy | 59.5 | 62.4 | 65.4 | 68.6 | 71.0 | 73.1 | 74.3 | 74.6 | 74.8 | 76.2 | 77.1 |
| Mortality rate | 10.73 | 9.21 | 8.56 | 7.30 | 6.37 | 5.94 | 6.31 | 6.65 | 7.06 | 6.66 | 7.08 |
| Under-5 mortality | 112.4 | 93.9 | 75.9 | 58.6 | 43.6 | 27.0 | 21.2 | 19.3 | 18.7 | 11.8 | 7.72 |
| Notes: Life expectancy is life expectancy at birth. Mortality rate is the crude mortality rate; i.e., annual number of deaths per 1,000 inhabitants. The under-5 mortality is the number of deaths of children up to age five, per 1,000 live births. | |||||||||||
According to The World Factbook, by 2009 Cuba had an average life expectancy of 78.05 years. [16] [ non-primary source needed ]
Cuba began a food rationing program in 1962 to guarantee all citizens a low-priced basket of basic foods. As of 2007, the government was spending about $1 billion annually to subsidise the food ration. The ration would cost about $50 at an average grocery store in the United States, but the Cuban citizen pays only $1.20 for it. The ration includes rice, legumes, potatoes, bread, eggs, and a small amount of meat. It provides about 30 to 70 percent of the 3,300 kilocalories that the average Cuban consumes daily. The people obtain the rest of their food from government stores (Tiendas), free market stores and cooperatives, barter, their own gardens, and the black market. [17]
According to the Pan American Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories):
Cuba, 3,286;
America, 3,205;
Latin America and the Caribbean, 2,875;
Latin Caribbean countries, 2,593;
United States, 3,754. [18]
| Place | Communicable | Non-communicable | Injuries |
|---|---|---|---|
| Cuba | 9 | 75 | 16 |
| World | 51 | 34 | 14 |
| High income countries | 8 | 77 | 15 |
| United States | 9 | 73 | 18 |
| Low income countries | 68 | 21 | 10 |
| Source: World Health Organization. World Health Statistics 2009, Table 2, "Cause-specific mortality and morbidity". | |||
Diseases of the circulatory system are the most common cause of death in Cuba, killing 306 people per 100,000 population in 2005. Neoplasms (cancer) are second, killing 173 per 100,000 population in 2005. The numbers killed by some other causes, in 2005 per 100,000 population, were: influenza and pneumonia 64, accidents 40, diabetes mellitus 18, intentional self-harm (suicide) 12, cirrhosis and other chronic liver diseases 10. Total mortality per 100,000 population was 754.[ citation needed ]
Abortion rates, which are high in Cuba, increased dramatically during the 1980s, but had almost halved by 1999 and declined to near-1970s levels of 32.0 per 1000 pregnancies. The rate is still among the highest in Latin America. [19] [ non-primary source needed ]
Among adults less than 49 years old, accidents are the leading cause of death, though occupational accidents have declined significantly in the last decade. The homicide rate is 7.0 per 100,000. The rate of suicide in the island is higher than average in Latin America and has been among the highest in the region and the world since the nineteenth century. [20] Annual suicide deaths per 100,000 population (2003–2005 data) were: Cuba 13.6, Americas 7.7, Latin America and Caribbean 5.8, Latin Caribbean 8.7, United States 10.8. [21] Among older adults heart disease and cancer predominate as causes of mortality. General mortality has been "characterized by a marked predominance of causes associated with chronic noncommunicable diseases", according to the Pan American Health Organization. [22] [ non-primary source needed ]
While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs and crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge. [23] [ non-primary source needed ]
According to WHO figures for 2016, Cuba (U5M) has an under-5 child mortality U5M rate of 5.5 per 1000 live births. [24] [25] [ non-primary source needed ]
The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. All healthcare in Cuba is free to Cuban residents, although challenges include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. There are no private hospitals or clinics as all health services are government-run. The current public health minister of Cuba is José Angel Portal Miranda.
The fundaments of the Brazilian Unified Health System (SUS) were established in the Brazilian Constitution of 1988, under the principles of universality, integrality and equity. It has a decentralized operational and management system, and social participation is present in all administrative levels. The Brazilian health system is a complex composition of public sector (SUS), private health institutions and private insurances. Since the creation of SUS, Brazil has significantly improved in many health indicators, but a lot needs to be done in order to achieve Universal Health Coverage (UHC).
Life expectancy has been rising rapidly and South Korea ranked 3rd in the world for life expectancy. South Korea has among the lowest HIV/AIDS adult prevalence rate in the world, with just 0.1% of the population being infected, significantly lower than the U.S. at 0.6%, France's 0.4%, and the UK's 0.3% prevalence rate. South Korea has a good influenza vaccination rate, with a total of 43.5% of the population being vaccinated in 2019. A new measure of expected human capital calculated for 195 countries from 1920 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. South Korea had the sixth highest level of expected human capital with 26 health, education, and learning-adjusted expected years lived between age 20 and 64 years.
The Tajikistan health system is influenced by the former Soviet legacy. It is ranked as the poorest country within the WHO European region, including the lowest total health expenditure per capita. Tajikistan is ranked 129th as Human Development Index of 188 countries, with an Index of 0.627 in 2016. In 2016, the SDG Index value was 56. In Tajikistan health indicators such as infant and maternal mortality rates are among the highest of the former Soviet republics. In the post-Soviet era, life expectancy has decreased because of poor nutrition, polluted water supplies, and increased incidence of cholera, malaria, tuberculosis, and typhoid. Because the health care system has deteriorated badly and receives insufficient funding and because sanitation and water supply systems are in declining condition, Tajikistan has a high risk of epidemic disease.
Niger is a landlocked country located in West Africa and has Libya, Chad, Nigeria, Benin, Mali, Burkina Faso, and Algeria as its neighboring countries. Niger was French territory that got its independence in 1960 and its official language is French. Niger has an area of 1.267 million square kilometres, nevertheless, 80% of its land area spreads through the Sahara Desert.
The current population of Myanmar is 54.05 million. It was 27.27 million in 1970. The general state of healthcare in Myanmar is poor. The military government of 1962-2011 spent anywhere from 0.5% to 3% of the country's GDP on healthcare. Healthcare in Myanmar is consistently ranked among the lowest in the world. In 2015, in congruence with a new democratic government, a series of healthcare reforms were enacted. In 2017, the reformed government spent 5.2% of GDP on healthcare expenditures. Health indicators have begun to improve as spending continues to increase. Patients continue to pay the majority of healthcare costs out of pocket. Although, out of pocket costs were reduced from 85% to 62% from 2014 to 2015. They continue to drop annually. The global average of healthcare costs paid out of pocket is 32%. Both public and private hospitals are understaffed due to a national shortage of doctors and nurses. Public hospitals lack many of the basic facilities and equipment. WHO consistently ranks Myanmar among the worst nations in healthcare.
According to the World Bank income level classification, Portugal is considered to be a high income country. Its population was of 10,283,822 people, by 1 July 2019. WHO estimates that 21.7% of the population is 65 or more years of age (2018), a proportion that is higher than the estimates for the WHO European Region.
The Human Rights Measurement Initiative finds that Cameroon is fulfilling 61.0% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Cameroon achieves 81.7% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 70.5% of what is expected based on the nation's level of income. Cameroon falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 30.9% of what the nation is expected to achieve based on the resources (income) it has available.
The Republic of Moldova has a universal health care system.
Examples of health care systems of the world, sorted by continent, are as follows.
The WHO's estimate of life expectancy for a female child born in Guinea-Bissau in 2008 was 49 years, and 47 years for a boy. in 2016 life expectancy had improved to 58 for men and 61 for women.
Lesotho's Human development index value for 2018 was 0.518—which put the country in the low human development category—positioning it at 164 out of 189 countries and territories. Health care services in Lesotho are delivered primarily by the government and the Christian Health Association of Lesotho. Access to health services is difficult for many people, especially in rural areas. The country's health system is challenged by the relentless increase of the burden of disease brought about by AIDS, and a lack of expertise and human resources. Serious emergencies are often referred to neighbouring South Africa. The largest contribution to mortality in Lesotho are communicable diseases, maternal, perinatal and nutritional conditions.
The quality of health in Rwanda has historically been very low, both before and immediately after the 1994 genocide. In 1998, more than one in five children died before their fifth birthday, often from malaria. But in recent years Rwanda has seen improvement on a number of key health indicators. Between 2005 and 2013, life expectancy increased from 55.2 to 64.0, under-5 mortality decreased from 106.4 to 52.0 per 1,000 live births, and incidence of tuberculosis has dropped from 101 to 69 per 100,000 people. The country's progress in healthcare has been cited by the international media and charities. The Atlantic devoted an article to "Rwanda's Historic Health Recovery". Partners In Health described the health gains "among the most dramatic the world has seen in the last 50 years".
A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by The Lancet in September 2018. Latvia had the twenty-first highest level of expected human capital with 23 health, education, and learning-adjusted expected years lived between age 20 and 64 years.
As of 2019 Lithuanian life expectancy at birth was 76.0 and the infant mortality rate was 2.99 per 1,000 births. This is below the EU and OECD average.
Compared with other neighbouring countries, Guyana ranks poorly in regard to basic health indicators. Basic health services in the interior are primitive to non-existent, and some procedures are not available at all. Although Guyana's health profile falls short in comparison with many of its Caribbean neighbours, there has been remarkable progress since 1988, and the Ministry of Health is working to upgrade conditions, procedures, and facilities. Many Guyanese seek medical care in the United States, Trinidad and Tobago or Cuba.
Health indicators are quantifiable characteristics of a population which researchers use as supporting evidence for describing the health of a population. Typically, researchers will use a survey methodology to gather information about a population sample, use statistics in an attempt to generalize the information collected to the entire population, and then use the statistical analysis to make a statement about the health of the population. Health indicators are often used by governments to guide health care policy or to make goals for improving population health.
The Health Sector in Eswatini is deteriorating and four years into the United Nations sustainable development goals, Eswatini seems unlikely to achieve the goal on good health. As a result of 63% poverty prevalence, 27% HIV prevalence, and poor health systems, maternal mortality rate is at a high of 389/100,000 live births, and under 5 mortality rate is at 70.4/1000 live births resulting in a life expectancy that remains amongst the lowest in the world. Despite significant international aid, the government fails to adequately fund the health sector. Nurses are now and again engaged in demonstrations over poor working conditions, drug shortages, all of which impairs quality health delivery. Despite tuberculosis and AIDS being major causes of death, diabetes and other non-communicable diseases are on the rise. Primary health care is relatively free in Eswatini save for its poor quality to meet the needs of the people. Road traffic accidents have increased over the years and they form a significant share of deaths in the country.
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