Sep 22, 2020
Prioritizing people over profits
The recent thaw in relations between the United States and Cuba has generated new hope for bi-lateral exchanges, although for now, the potential remains largely in the realm of collective imagination. The tourism industry imagines white sand beaches and resorts visited by American cruise ships, the telecom industry imagines an explosion of cell towers and Internet providers on the island, and a number of Americans imagine smoking Cohiba cigars and sipping Havana Club rum. But, thanks to the Oakland, California-based Medical Education Cooperation with Cuba (MEDICC), a trans-national exchange that prioritizes people over profits does not need to be imagined. It has existed for nearly two decades.
In 2012, I joined a group of New Mexican public healthcare providers, administrators, advocates and researchers, with an interest in improving the health of residents of Albuquerque’s South Valley, on a weeklong MEDICC trip to Havana. MEDICC is a nonprofit organization that promotes cooperation among U.S., Cuban and global health communities to improve health outcomes and equity and uses the Cuban experience to inform global debate, policies and practice. MEDICC, in conjunction with Francisco Ronquillo and doctors Art Kaufman, Martha McGrew and Pope Mosely from the UNM Health Science Center, organized two separate groups of 15 people from Albuquerque to visit Havana. The purpose of the trip was to gain a better understanding of the Cuban healthcare system.
The week included visits to consultorios—community-based clinics that are also the homes of the local physician and nurse, polyclinicas—regional, specialty clinics, and to tertiary level hospitals. The visit also included opportunities to meet with scholars at the National School of Public Health (ENSAP) and with international students at the Latin American Medical School (ELAM), one of the largest medical schools in the world. We were even able to sneak away to hear the incomparable Nueva Trova singer and songwriter Silvio Rodriguez playing a street concert.
“We live like poor people, but die like rich people.”
Our experience observing and learning from the Cuban healthcare model provided a counterpoint to the disparities in health access and outcomes in the South Valley. Despite being one of the poorest countries in the hemisphere, Cuba is among the countries with the best health indicators in the world. Cubans told us, “We live like poor people, but die like rich people.” With the average life expectancy at 78 years, they live almost as long as the average American. Yet they have a higher doctor-patient ratio (6.7per 1,000 people in Cuba vs. 2.6 per 1,000 people in the U.S.) and a lower infant mortality rate than the U.S. (4.7 per 1000 live births in Cuba vs. 5.9 in the U.S.). Cuba has universal access to free healthcare. In New Mexico, even after the implementation of the Affordable Care Act (ACA) and the expansion of Medicaid benefits, more than 15 percent of the state’s population remains uninsured.
The secret? An investment in human capital.
The secret to Cuba's success, we learned, was an investment in human capital. Economic hardships generated from the embargo and exacerbated by the collapse of the Soviet bloc in 1989 generated a period of crisis in the early ’90s known as the “special period.” Food, clothing and medication were scarce, and the situation forced Cubans to economize in every aspect of their lives. During this time, Cuba developed strategies including emphasis on upstream, cost-saving policies. Epidemiological focus, cross-sector collaboration and early intervention in Cuba have been undeniably successful and contrast with downstream, individualized and crisis-response focus that characterizes the U.S. system. I spoke with Cuban doctors who couldn’t fathom why on a good year in New Mexico only 75 percent of children are fully immunized, when in Cuba the rates are 99 percent.
Click here to read the entire article published in November 2015 in the Green Fire Times.
About the author
Bill Wagner, Ph.D., LCSW, is the founder and director of Centro Sávila, a nonprofit outpatient behavioral health program in Albuquerque’s South Valley that provides affordable mental health and social services. Centro Sávila is the fiscal sponsor and a collaborator with the ACCESS and Girasol programs in the South Valley Community Partnership for Health Equity.