Analysing the Cuban health miracle

A new book by RMIT University academic Dr Elizabeth Kath looks beyond the statistics to analyse the true story behind Cuba’s extraordinary public health performance.

Dr Kath spent five years, including nine months of fieldwork in Cuba, conducting research for her book, Social Relations and the Cuban Health Miracle.

The state’s health indicators outperform all nations at similar levels of economic development, with some of its health statistics rivaling those of wealthy industrialised countries.

Dr Kath, a research fellow with the RMIT Global Cities Research Institute, said she wanted to unravel the puzzle of how such a poor nation could have achieved such excellent health outcomes in the face of poverty and major external crises.

"I found that Cuba has an unusually high level of popular participation and cooperation in the implementation of its health policy," she said.

"This has been achieved with the help of a longstanding government that sets and prioritises clear, long-term health goals, and has enough political influence to compel the rest of the community to do the same.

"But on the other hand, popular participation in decision-making regarding health policy is minimal, which contrasts with the image of popular participation that is often promoted by Cuba.

"The country’s political elites design and impose health policy, allowing little room for other health sector groups to meaningfully contribute to or protest against official decisions.

"This is a problem because aspects of health care that are important to those who use the system or work within it can be neglected if they do not fit within official priorities."

Dr Kath said there were lessons for Australia from the health advances that had been made in Cuba.

"That a poor country facing multiple internal and external crises has been so successful in improving key health outcomes - particularly maternal, infant and under-five mortality rates - should be a point of interest for Australia," she said.

"While Cuba and Australia are different contexts, lessons can be drawn that would be useful in the bid to 'close the gap' on Indigenous health inequality.

"What we can learn from Cuba generally is that health, especially maternal-child health, is not only a question of spending and financial resources.

"Improving health outcomes among our most disadvantaged communities relies as much on social, non-economic investments as it does on resource mobilisation."

Dr Kath found factors underlying Cuba’s ability to improve its maternal-infant and other health outcomes included:

• the sustained, long-term pursuit of clear health goals;
• a proactive system of surveillance and prevention to avert risk factors;
• access to free basic health services close to home;
• institutionalised relationships ensuring close and regular contact between health workers and the population; and,
• inter-sectoral and inter-institutional cooperation in the pursuit of health goals.

"Cuba’s health strategy does have problems, such as the lack of genuine community participation in health decision-making," Dr Kath said.

"This has contributed to a number of emergent problems with the country’s health system that threaten to undermine the sustainability of its positive achievements.

"One of the lessons for Australia from my research is the vital importance of ensuring local Indigenous communities are not just participants in the discussion and implementation of health policy, but that they are also genuinely involved in individual and collective health decisions."

Social Relations and the Cuban Health Miracle ($49.95) is published by Transaction.

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