US could learn from Cuba, say healthcare experts


US could learn from Cuba, say healthcare experts

Published on Tuesday, July 24, 2007

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WASHINGTON, USA (UPI):  The United States could learn a thing or two from Cuba’s healthcare system, some experts say, particularly as US policymakers delve into healthcare reform.

Although Cuba probably isn’t the first thing to pop into most Americans’ minds when they picture efficient healthcare, the small country challenges stereotypes of healthcare in poor regions, said Paul Farmer, a professor of medical anthropologies at Harvard Medical School.

"The most important contribution that Cuba’s given to global healthcare is (an) example — the idea that you can introduce the notion of broad healthcare and wipe out the diseases of poverty," Farmer said in "Salud!," a recently released documentary about Cuba’s healthcare system.

Despite its low per-capita income, Cuba excels in providing preventative, comprehensive care to its citizens, said William Keck, a professor at Northeastern Ohio Universities College of Medicine and the producer of "Salud!"

"Cuba has managed to do a great deal in terms of health status with comparatively few resources," Keck said at a panel discussion hosted by The Rockefeller Foundation and The Atlantic Philanthropies.

In fact, data from the World Health Organization shows little difference in health benchmarks between the United States and Cuba.

In 2004 the life expectancy for Cuban women exactly equaled that of American women, and the statistic for Cuban men came in just one year younger than the projected age for men in the United States. The healthy life expectancy, probability of dying under age 5 and average number of deaths for 15- to 60-year-old Cubans also came close, and sometimes yielded better numbers, than the same statistics for Americans.

In part, these similarities between data reflect the high degree of health disparity in the United States that creates a wide gap between the health outcomes for the rich and those for the poor, Keck said.

"We have areas that are more healthy than most areas in Cuba, but we also have areas that are much less (healthy), and when you average them out, it comes out to about the same" he told United Press International. "When you go to Cuba, there are differences geographically and regionally, but they’re much less (than in the United States) … it’s a much more egalitarian approach."

Although average health outcomes in the two countries may be similar, when it comes to cost, the numbers don’t even come close.

While the United States spent $6,094 per person per year in 2004, or 15.4 percent of its gross domestic product, Cuba spent only $229 per person, or 6.3 percent of GDP.

Cuba operates on a socialized medicine system, providing free healthcare to all citizens, and relies heavily on manpower to keep its system alive. Having enough doctors and nurses is essential, because they compensate for a lack of equipment and shortages of pharmaceuticals, said Fitzhugh Mullan, head professor of medicine and health policy at the George Washington University School of Public Health and Health Services.

"Cuba has a workforce of more than 60,000, which makes it one of the best resourced countries in the world," Mullan said.

This large workforce — almost double the number of physicians per capita in the United States — allows for personalized care administered by doctors who live in the communities they serve. Most family physicians spend the afternoons making home visits, teaching in the community and holding public health events.

Although the Cuban system has many benefits, social and political differences would make it difficult to uproot it and plant it in the United States, Mullan said. However, some of these practices could be encouraged through policy changes that support programs like the National Health Service Corps, a program that provides loan repayments and scholarships for doctors willing to work in poor communities, he said.

"These are areas where this model of community-based care is more realistic and is really a necessity," Mullan said.

For medical students graduating with debts of up to $200,000, the lower wages of a primary care physician in a poor area can be difficult to swallow, said Sandeep Krishnan, a student at the University of Missouri-Kansas City Medical School.

"It’d be cool to get back and help in a rural area," Krishnan told UPI. "On the other hand, debt is a big deal."

In addition to the lure of higher salaries elsewhere, some medical students are dissuaded from working in primary care by the stigma attached to it.

"If you say to your attending physician you want to be a family physician, they’ll be like, ‘You’re too smart for that,’" Krishnan said.

In an attempt to introduce some of the benefits of the Cuban approach to medicine into the United States, one non-profit organization helps US students receive their medical training in Cuba. The students receive a full scholarship from the Cuban government on the condition that they work in a poor community in the United States upon graduation.

"Tomorrow is graduation day for the first batch of (eight) US students," said Gail Reed, international director of the Medical Education Cooperation with Cuba.


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One Response to US could learn from Cuba, say healthcare experts

  1. R. says:


    Cuba-trained US physicians fear prejudice back home

    Published on Wednesday, July 25, 2007
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    HAVANA, Cuba (AFP):  Eight Americans who graduated Tuesday from medical school in Cuba fear prejudice back home, but said their education, training and dedication should help them overcome any obstacle. "It\’s inevitable we\’ll be facing and confronting prejudice when we get there due to the political situation between our two countries, but when we can show we\’re well prepared technically, those prejudices will fall away," one of the doctors, Teresa Thomas, told a press conference. She and seven other Americans are among 1,842 doctors from 30 countries to have graduated Tuesday from Havana\’s Latin American School of Medicine, after six years of study under a full scholarship program granted by Cuba. Applicants to the school are chosen from poor areas around the world by Pastors for Peace, a special ministry of the US-based Interreligious Foundation for Community Organization headed by Reverend Lucius Walker. Walker told the press conference it was "a very special day" for his oranization, adding that 100 Americans were currently studying to be doctors at the Havana school and that 18 more would be arriving in late August. When the graduates return to the United States, he said, they have to pass three equivalency exams to validate their medical degree, but that they were already "fully and well trained" to practice medicine in the United States. Pastors for Peace official Ellen Bostein said the US graduates were very sought after in the United States "because they have received excellent training in primary health care, disease prevention and are all bilingual." Toussaint Reynolds, who like Thomas is from New York City, said in Cuba he learned that "medicine is not a business but a social and human occupation." "Everything is politics," the freshly-graduated doctor told reporters, "but if the United States would give young blacks from poor backgrounds the possibility to study in their own country, they wouldn\’t have to come to Cuba." The medical education those Americans get in Cuba, he said, would cost 200,000 dollars in the United States. "That\’s something their families cannot afford," Reynolds added.

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