BY CHRONICLE STAFF
In Sicko, the new movie by controversial writer-director Michael Moore, there is brief, 15-minute segment showing September 11 rescue workers getting treatment in Cuba. The movie, scheduled for a U.S. release next week, is aimed to be an exposé of the deficiencies of the U.S. healthcare system and the Cuba segment indicates that the Caribbean island has better healthcare than the United States.
Latin Business Chronicle asked several Cuba experts for their opinion on how good the Cuban healthcare system is and how it compares with the U.S. healthcare system.
"After many years of increasing disrepair, the Cuban health system is now in crisis," says Jorge Salazar-Carrillo, a professor of economics at Florida International University and expert on Latin American economies.
In reality, Cuba has three types of health systems, argues Jaime Suchlicki, the director of the Institute for Cuban and Cuban-American Studies at the University of Miami and a leading expert on Cuba. One for the Cuban military, members of the Communist Party and leaders of the government. A second one is for foreigners who pay in dollars or foreign currency and a third one for the general Cuban population.
"The first two are excellent, with modern equipment and availability of medications," he says. "The third, which is for the majority of the Cubans, is a veritable disaster with poor equipment and few medications and in many instances without the availability of Cuban specialists."
Salazar-Carrillo agrees. While Cuba has a high ratio of family doctors per inhabitant, the actual offer for ordinary Cubans is low. About half of the doctors are being exported to the poor countries of the world for hard currency (mainly Venezuela), while a similar portion is at the service of the Cuban Armed Forces and their families, he says. "Thus, at present the real availability to the populace is meager," says Salazar-Carrillo. "Cuba does not train the standard proportion of specialists."
However, Cuba does rank well in international surveys on mortality, maternal mortality, and life expectancy, points out Eliseo J. Pérez-Stable, a professor of medicine at the University of California at San Francisco. "Cuba ranks near the top on all these parameters in all of Latin America and I believe similar to the U.S. or just below," he says. "These are results obtained by addressing the basic public health issues of infectious disease control, basic nutrition and care for the high risk infants."
Nevertheless, even the official statistics are showing a worrisome trend. "For many years now, Cuba has been reported in the international health statistics as deficient in proteins and calories, even using the mendacious Cuban statistics," Salazar-Carrillo says.
This should not be surprising since milk is only distributed in Cuba to children under seven, those infirm, or over 65, he points out. "In the last decade and a half there have been several epidemics and the island is on the watch list of infectious disease specialists," Salazar-Carrillo says.
Although Cuba markets itself as an advanced medical treatment center for foreign patients, it struggles to provide basic medicines to its own population, experts say."Medications are difficult to obtain in Cuba,Suchlicki says. "And [it] is not because of the U.S. embargo which excludes medicine."
The main reason is that the Cuban government spends money primarily on its own elite and foreign health patients, he says.
Salazar-Carrillo estimates Cuba receives $300-400 million a year in humanitarian aid from the United States in the form of medicines and medical devices. Despite that, there is a serious shortage for the Cuban population, he says. "Medicine [is] very unavailable in
Pérez-Stable believes the U.S. embargo does play a factor in the lack of medicines. "The pharmaceutical industry is global and many products are not sold to Cuba either because of the economic embargo or because Cuba will not pay the high prices," he says.
CUBA BETTER THAN USA?
So, is Cuba's healthcare system better than the United States, as is implied in Sicko? "Are you kidding?" says Salazar-Carrillo. "The U.S. is considered the best healthcare system in the world and Cuba ranks among the lowest or worst." Suchlicki concurs. The Cuban system is not better, but it’s free, he says.
"Although there is universal access to care in Cuba and some selected aspects of the health care system may at times compare favorably with the U.S., I don’t believe anyone would say with any degree of believability that it is “better” than the US," says Pérez-Stable. "This would especially apply in the persons with chronic diseases such as diabetes, heart failure or any form of cancer. "
The Cuban health care system may be very “cost efficient” in that the favorable outcomes are obtained at a relatively modest investment, while the U.S. system is known for being the most expensive, yet having inferior outcomes to many developed European countries and Japan, he says.
However, there are areas where Cuba has not done as well as one may have expected, Pérez-Stable argues. "Cervical cancer rates remain two to three times that in the U.S. when access to Pap smears and treatment should have led to similarly low rates," he says. "Cuba is also experiencing the biggest lung cancer epidemic in the Americas outside the U.S. and Canada and this may have been preventable 20 years ago with a concerted effort to control tobacco smoking."
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