Health Care in Cuba: Myth Versus Reality

Cuba's Economic Choice: The Regime's Health Over the People's

Cuba's economy is in disarray as a direct result of its government's  continued adherence to a discredited communist economic model. This decline has directly affected the health of ordinary Cubans. Lack of chlorinated water, poor nutrition, deteriorating housing, and generally unsanitary conditions have increased the number of cases of infectious diseases, especially in concentrated urban areas like Havana.

The grave economic problems in Cuba were exacerbated by the demise of the Soviet Union and the ending of the $5 billion in subsidies that the U.S.S.R. gave annually to the Castro government. Cuba made significant advances in the quality of health care available to average citizens as a result of these subsidies. However, it devoted the bulk of its financial windfall to maintaining an out-sized military machine and a massive internal security apparatus.

The end of Soviet subsidies forced Cuba to face the real costs of its health care system. Unwilling to adopt the economic changes necessary to reform its dysfunctional economy, the Castro government quickly faced a large budget deficit. In response, the Cuban Government made a deliberate decision to continue to spend money to maintain its military and internal security apparatus at the expense of other priorities--including health care.

According to the Pan American Health Organization, the Cuban Government currently devotes a smaller percentage of its budget for health care than such regional countries as Jamaica, Costa Rica, and the Dominican Republic.

Health Care in Cuba: "Medical Apartheid" and Health Tourism

Of course, not everyone in Cuba receives substandard health care. In fact, senior Cuban Communist Party officials and those who can pay in hard currency can get first-rate medical services any time they want.

This situation exists because the Cuban Government has chosen to develop a two-tiered medical system--the deliberate establishment of a kind of "medical apartheid"--that funnels money into services for a privileged few, while depriving the health care system used by the vast majority of Cubans of adequate funding.

Following the loss of Soviet subsidies, Cuba developed special hospitals and set aside floors in others for exclusive use by foreigners who pay in hard currency. These facilities are well-equipped to provide their patients with quality modern care. Press reports indicate that during 1996 more than 7,000 "health tourists" paid Cuba $25 million for medical services.

Cuba's "Medical Technology Fair" held April 21-25 presented a graphic display of this two-tier medical system. The fair displayed an array of both foreign and Cuban-manufactured medicines and high-tech medical equipment and services items not available to most Cubans. The fair showcased Cuban elite hospitals promoted by "health tourism" enterprises such as SERVIMED and MEDICUBA.

On the other hand, members of the Cuban Communist Party elite, and the military high-command are allowed to use these hospitals free of charge. Certain diplomatic missions in Havana have been contacted and told that their local employees can be granted access privileges to these elite medical facilities--if they pay in dollars.

The founder of Havana's International Center for Neurological Restoration, Dr. Hilda Molina, in 1994 quit her position after refusing to increase the number of neural transplant operations without the required testing and follow-up. She expressed outrage that only foreigners are treated. Dr. Molina resigned from her seat in the national legislature, and returned the medals Fidel Castro had bestowed on her for her work.

In 1994, Cuba exported $110 million worth of medical supplies. In 1995, this figure rose to $125 million. These earnings have not been used to support the health care system for the Cuban public. In fact, tens of millions of dollars have been diverted to support and subsidize Cuba's biomedical research programs--money that could have been used for primary care facilities.

Another means of earning foreign exchange at the expense of providing health care to ordinary Cubans is the government's policy to export its doctors to other countries. South Africa alone has nearly 300 Cuban doctors. Cuba, in the early 1990s, reportedly planned to have 10,000 physicians abroad by the turn of the century.

A group of Cuban doctors recently arrived in the United States said they were "mystified" by claims in a recent report of the American Association for World Health (AAWH) that the United States embargo is to be blamed for the public health situation in the country.

According to these doctors, "we . . . can categorically and authoritatively state that our people's poor health care situation results from a dysfunctional and inhumane economic and political system, exacerbated by the regime to divert scarce resources to meet the needs of the regime's elite and foreign patients who bring hard currency."

Referring to the growing disparity between health care provided to ordinary Cubans and that offered to tourists and high ranking Communist party members, the exiled Cuban doctors noted that they "wish that any one of us could provide tours to foreign visitors of the hospitals Cira Garcia, Frank Pais, CIMEQ, and Hermanos Ameijeiras, in order to point out the medicines and equipment, even the bedsheets and blankets, reserved for regime elites or dollar-bearing foreigners, to the detriment of our people, who must bring their own bedsheets, to say nothing of the availability of medicines."

This statement by these newly arrived Cuban doctors is corroborated by the latest available trade figures for Cuba (1995). Cuba's imports totaled $2.8 billion dollars, yet only $46 million dollars--only 1.5% of overall foreign purchases--on medical imports for its 11 million people. By comparison, Cuba's neighbor, the Dominican Republic, spent $208 million dollars on medical imports for its 7.5 million citizens in 1995.

U.S. Sales of Medicines and Medical Supplies to Cuba

The US embargo does NOT deny medicines and medical supplies to the Cuban people. As stipulated in Section 1705 of the Cuban Democracy Act of 1992, the U.S. Government routinely issues licenses for the sale of medicine and medical supplies to Cuba. The only requirement for obtaining a license is to arrange for end-use monitoring to ensure that there is no reasonable likelihood that these items could be diverted to the Cuban military, used in acts of torture or other human rights abuses, or re-exported or used in the production of biotechnological products. Monitoring of sales can be performed by independent non-governmental organizations, international organizations, or foreign diplomats.

Since 1992, 36 of 38 license requests have been approved to U.S. companies and their subsidiaries to sell medicine and medical equipment to Cuba. Sales have included such items as thalamonal, depo-provera, pediatric solutions, syringes, and other items. The Department of Commerce declined the other two requests for licenses it received for failure to meet legal standards. Both of these exceptions to the general policy of approving commercial medical sales occurred in 1994.

Moreover, the U.S. embargo on Cuba affects only U.S. companies and their subsidiaries. Other nations and companies are free to trade with Cuba. Should Cuba choose not to purchase from the U.S., it can purchase any medicine or medical equipment it needs from other countries. Such third-country transactions only cost an estimated 2%-3% more than purchases from the U.S. as a result of higher shipping costs.

Humanitarian Assistance

The Cuban Democracy Act encourages the donation of humanitarian supplies to the people of Cuba, including medicine, food, and clothing.

Since the passage of the Cuban Democracy Act, the U.S. has become the largest donor of humanitarian assistance to Cuba. Much of the humanitarian assistance by U.S. non-governmental organizations consists of medicines and medical equipment. The U.S. Government has licensed more than $150 million in humanitarian assistance to Cuba over the last four years. That is more than the total of worldwide foreign aid to Cuba during that period.

U.S. humanitarian assistance has been distributed throughout the island, including to medical clinics. Monitoring is not required for donations of medicines for humanitarian purposes to non-governmental organizations in Cuba.

In addition it is believed that the single largest source of medicines used in Cuba today is the large volume of "care packages" sent to Cuba by family members living in the U.S. These "care packages" are worth millions of dollars each year.

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