Cuba’s Health Politics: At Home and Abroad

1 For a full discussion of the history, ideology and organisation of the Cuban health system, and its medical diplomacy and biotechnology development, see Julie M. Feinsilver, Healing the Masses: Cuban Health Politics at Home and Abroad, Berkeley: University of California Press, 1993.

2 Ibid., pp. 37-40.

3 Médicos de la familia y cobertura según provincias, Anuario Estadístico de Salud 2007, Fuente: Registro de profesionales de la salud y Dirección de Atención Primaria, 2007, http://bvs.sld.cu and Oficina Nacional de Estadisticas, Anuario Estadística 2008 (Edición 2009), Tables 19.1, 19.4 and 19.5 Coverage was reorganized in late 2007. There were 932 fewer family doctors in 2008 than 2006, which could be due to a number of factors such as natural attrition, further specialization, system rationalization or defection while abroad.

4 Feinsilver, Healing the Masses, pp. 117-18.

5 Ibid., pp. 40-41, 44-47.

6 Ibid., pp. 58-62, 122-55.

7 ‘La Reforma Del Sector de la Salud’, available from http://www.dne.sld.cu.

8 Pan American Health Organization (PAHO), Health in the Americas 2007, Washington: PAHO, 2007, available from http://www.paho.org.

9 Ibid.

10 Table 87, ‘Ejecución del presupuesto y gasto por habitante 1959, 1960, 1965, 1970 – 2006’, Año anuario 2006, Fuente: Registros administrativos de la Dirección Nacional de Finanzas y Contabilidad.

11 República de Cuba, Dirección Nacional de Estadística del Ministerio de Salud Pública, Sistema Nacional de Salud Políticas, Estrategias y Programas. Havana, Cuba, December 1998. ‘La Reforma Del Sector de la Salud’.

12 PAHO, Health Situation in the Americas. Basic Indicators 2007, p. 4.

13 Republica de Cuba, Ministerio de Salud Pública, Proyecciones de la Salud Pública en Cuba para el 2015, Havana: Editorial Ciencias Médicas, February 2006, p. 64.

14 Abelardo Ramírez Márquez and Cándido López Pardo, ‘A Monitoring System for Health Equity in Cuba’, MEDICC Review, 7(9), Nov/Dec 2005, available from http://ww.medicc.org.

15 Ministerio de Salud Pública, Proyecciones.

16 Republica de Cuba, Oficina Nacional de Estadísticas, Anuario Estadístico de Cuba 2008 (Edición 2009), available from http://www.one.cu/aec2008/esp/20080618_tabla_cuadro.htm.

17 Feinsilver, Healing the Masses, Chapter 6, ‘Cuban Medical Diplomacy’ (on comparison with the former Soviet bloc and China, see pp. 159-160).

18 Interview with Carlos Lovo, Advisor to the Salvadoran Minister of Health at that time, Washington, 30 April 2009.

19 Cuban Cooperation, Website of the Cuban Governmental Cooperation in the Health Sector, http://www.cubacoop.com (available in Spanish and English); and ‘Cubans to help boost local health sector’, Jamaica Observer, 10 May 2008.

20 Feinsilver, Healing The Masses, Chapter 6.

21 ‘Cuban medical cooperation in South Africa highlighted’, Cuba Direct (online),
26 May 2009, available from http://emba.cubaminrex.cu.

22 http://www.cubacoop.com.

23 Prensa Latina, 11 April 2008.

24 http://www.cubacoop.com.

25 AFP, ‘Massive UN vote in support of lifting US embargo on Cuba’, 29 October
30 2008.

26 http://www.cubacoop.com.

27 Ibid.

28 Aleksei Aleksandrov, ‘Health care: The secrets of Cuban medicine’, Argumenty i Fakty (mass-circulation weekly), Moscow, 17 September 2003, reprinted in World Press Review, 50(12), 2003; and ‘Over 20,000 children from Chernobyl rehabilitated in Cuba,’ Caribbean Net News, 2 April 2009, available from http://www.caribbeannetnews.com.

29 Feinsilver, ‘La diplomacia médica cubana: cuando la izquierda lo ha hecho bien
[Cuban medical diplomacy: When the left has got it right]’, Foreign Affairs en
Español, 6(4), 2006, pp. 81-94. The English version is available from http://
www.coha.org.

30 Feinsilver, ‘Cuba as a world medical power: the politics of symbolism’, Latin American Research Review, 24(2), 1989, p. 1; and Healing the Masses.

31 Feinsilver, ‘Médicos por petroleo: la diplomacia médica cubana recibe apoyo de sus amigos [Oil-for-Doctors: Cuban medical diplomacy gets a little help from a Venezuelan friend]’, Nueva Sociedad, 216(July-August), 2008, available in both English and Spanish from http://www.nuso.org; and Feinsilver, ‘La diplomacia médica cubana’.

32 Dr. Miriam Gran Álvarez, ‘Estructura de la BMC’, 1 February 2008, available from http://colaboracion.sld.cu.

33 ‘Report on Cuban healthcare professionals in Bolivia’, Periódico 26, 16 July
2008, available from http://www.periodico26.cu.

34 http://www.cubacoop.com.

35 Prensa Latina, 4 August 2008.

36 Interviews with Doctors Félix Rigoli and Eduardo Guerrero, PAHO, Washington, 30 April 2009; UVS website http://www.uvirtual.sld.cu; Steve Brouwer, ‘Fidel’s WMDs versus Bush’s WMDs: World medical doctors are more powerful than weapons of mass destruction’, 14 November 2008 and ‘WMDs – World Medical Doctors – now being produced in Venezuela’, 13 November 2008, both posted to the blog site, Venezuela Notes, and available at http://www.venezuelanotes.blogspot.com; and ‘Cuba: More Doctors for the World’, MEDICC Review, 14 April 2008, available from http://www.medicc.org.

37 Personal communication from Saul Landau, whose daughter was one of those who passed the FMG in the US, 8 May 2009.

38 Data on medical graduates from a personal communication from Dr. Francisco Rojas Ochoa, Distinguished Professor and Editor of Revista cubana de salud pública, February 3, 2010; and Prensa Latina, 11 April 2008.

39 Embassy of India (Havana), ‘Annual Commercial & Economic Report-2006’, No.Hav/Comm/2007, 13 April 2007.

40 Carmelo Mesa-Lago, ‘The Cuban economy in 2008-2009: Internal and external challenges, state of the reforms and perspectives’, International Seminar on Cuba, Tulane University and Centro de Investigación y Adiestramiento Político Administrativo, San Jose, Costa Rica, 3-4 February 2009 (to be published in a book edited by Paolo Spadoni).

41 Interview with Dr. Félix Rigoli, PAHO, 30 April 2009.

42 Tal Abbady, ‘Hundreds of Cuban medical workers defecting to US while overseas’, South Florida Sun-Sentinel, 10 October 2007 (posted at http://www.coha.org).

43 Elise Andaya, ‘The Gift of health: Socialist medical practice and shifting material and moral economies in post-Soviet Cuba’, Medical Anthropology Quarterly (2009).

44 Ibid. and Pierre Sean Brotherton, ‘We have to think like capitalists but continue being socialists: Medicalized subjectivities, emergent capital, and socialist entrepreneurs in post-Soviet Cuba’, American Ethnologist, 35(2), May 2008.

45 Abbady, ‘Hundreds of Cuban medical workers defecting’.

46 The nature of the activity of defection makes valid estimates difficult. Neither Homeland Security nor the State Department’s Cuba Desk would provide any information and said that they did not have that data. Abbady cites Rep. Lincoln Diaz-Balart’s office indicating that 1,000 Cuban doctors have come to the US under a special program announced in 2006.

47 US Department of Homeland Security, US Customs and Immigration Services, ‘Fact Sheet: Parole for Cuban Medical Personnel in Third Countries’, 19 September 2006.

48 Mike Ceasar, ‘Cuban doctors abroad helped to defect by new us visa policy’, World Politics Review, 1 August 2007.

49 Oficina Nacional de Estadisticas, Anuario Estadistico 2008 (Edición 2009), Table
19.21.

50 Ibid., Table 19.4.

51 On the disparity between rhetoric and practice and the nature of doctor-patient relations in the Cuban health system, see Pierre Sean Brotherton, ‘Macroeconomic change and the biopolitics of health in Cuba’s special period’, Journal of Latin American Anthropology, 10(2), 2005; Brotherton, ‘We have to think like capitalists’; and Elise Andaya, ‘The gift of health’.

52 María Isabel Domínguez, ‘Cuban social policy: principal spheres and targeted social groups’, Latin American Perspectives, 36(2), March 2009.

53 Feinsilver, ‘Médicos por petroleo [Oil-for-Doctors]’.