Where No Doctor Has Gone Before: Cuba’s Place in the Global Health Landscape

Chapter 2. Sowing the Seeds of Health as a Right: The Origins of Health Care in Cuba

31 There are so many stories of structural and economic hardships coming out of Cuba, from overcrowded buses to faulty water systems (Ritter, 2010). In rural areas, there are outspoken complaints about the distribution of certain resources and sporadic transportation. There are critiques against the freedom of expression of political opposition movements and the nature of political representation (“Cuban ladies,” 2010). Other critiques focus on how many university-trained graduates wind up with mid-level jobs in government ministries. There are plenty of points of critique regarding the Cuban economy and its political institutions just as there are plenty of points to critique any political system. In Canada, for example, there is no shortage of sociopolitical critiques to be made on the increase in child poverty, the marginalization of First Nations peoples, urban homelessness, and democratic transparency (Russell & Sossin, 2009). Public transit in Toronto is in crisis, as are the waterworks in Montreal. Access to health-care resources in northern Canada are often lacking, and transit from the Arctic to major urban centres is enormously expensive. How many university graduates in Canada find only low-paying jobs outside of their desired fields? Some observers even question whether to maintain our archaic political system that appoints, rather than elects, senators. So if Cuba, despite its own social problems and political challenges, puts attention to global health, why is it that other nations do not? When considering the numerous social and economic problems faced by wealthy countries, liberal societies, or emerging economies in the global South, why is there not a solid commitment to health care as a right? SOWING THE SEEDS OF HEALTH AS A RIGHT: THE ORIGINS OF HEALTH CARE IN CUBA CHAPTER 2 WHERE NO DOCTOR HAS GONE BEFORE 32 This chapter explains the internal organization of Cuba’s health-care system against internal economic chaos. The focus is on the post-revolution period and the fall of the Soviet Union in 1991, which threw Cuba into the Periodo Especial. The message here is that in both economic periods Cuba faced enormous crises, but with political will and with social mobilization the country emerged from crisis by investing in their strongest natural resource: each other. Two Common Prejudices against Learning from Cuba Why would a resource-flush country take pointers from Cuba be it in global health or in any other matter? After all, Canada enjoys universal public health care and dedicates significant attention towards international aid and humanitarian interventions. While Canada makes generous contributions to global health causes, Canada’s humanitarian efforts to deliver primary care to the global poor fall short of Cuba’s medical internationalism, and even at home, Canadian medicare continues to struggle with rising costs and wait times for elective non-life-threatening treatments. Moreover, the geographies of the two countries are radically different and the economies cannot be easily compared; Canada is dependent upon the United States for 81 percent of its exports while Cuba lives under an embargo. There are also differences in democratic processes and principles between the two countries. These are all fair points when discussing economic geography, but when it comes to taking lessons from Cuban approaches to health care, the conversation rarely gets far because of two common prejudices: • Cuba is a communist country. • It is not within the thinking of a liberal market, multi-party democracy to invest in the long-term capacity as Cuba did. The first bias is easily overcome through an understanding that Cuba is a complex society where people do exercise personal agency on a daily basis. Roman (2003) and Saney (2004) have written extensively on this. Simply put no one-man, green suit or not, is an island. The maintenance and expansion of Cuba’s health-care system was managed centrally, but it relied on popular participation at the local level across the country (Feinsilver, 1993). There are stories of Cuban doctors finding their way to resorts and others taking to the United States for better salary (Millman, 2011). While some resort workers do carry medical degrees, today the majority of workers in the tourist trade are graduates from Cuba’s hospitality and tourism training institutes. Still, official US policy largely views Cuba as repressive and destructive to human capabilities. The US Department of State’s Commission for Assistance to a Free Cuba notes that, “The physical, mental, and emotional health of the CHAPTER 2 / Sowing the Seeds of Health...