Laurie Garrett
Will Lifting the Embargo on Cuba Make Things Worse?
By any measure, these achievements are laudable. But they have come at tremendous financial and social cost. The Cuban government's 2008 budget of
Overlooked in these dreamy discussions of lifestyle improvements, however, is that
MEDICAL HELP WANTED
After half a century of socialist rule, there remain clearly distinct social classes in
When they take ill (or need liposuction), the more privileged residents of
The clinic's Canadian clients favor family package deals that allow children to play on local beaches while their parents get a new knee
But a lot may change if
And any such brain drain within
According to the
Primary-care physicians are the worst-paid doctors in
REVOLUTIONARY MEDICINE
The two keys to
By the early 1980s,
Now, with its rapidly aging population,
Today, more than 80 percent of
In a second effort to increase agricultural productivity, the regime now allows farmers to sell some meat and produce in urban markets through third-party dealers. Goods sold in this so-called flea-market economy go for high prices relative to average earnings. And transactions are executed in Cuban convertible pesos (also called convertible units of currency, or CUC), which are pegged to the U.S. dollar. But most Cubans have few CUC: they are paid in Cuban pesos, which have no international value and are traded domestically at a rate of 25 to one against the CUC. CUC-bearing Cubans are often connected to an elaborate network of relatives overseas, particularly in
Cubans without foreign connections and access to remittances barely survive on an old Soviet-style food-rationing system that provides each household with coupons redeemable for basic foods and sundries. Worse, the government is now scaling back elements of its rationing programs, limiting the range of staples and cleaning products that it subsidizes. President Raúl Castro, who realizes that the Cuban economy is unsustainable in its current form, favors eliminating other government programs, including some that provide make-work jobs -- in which Cubans are paid for unproductive labor to provide them with some wages and to keep the unemployment figures low.
Officially, unemployment in 2008 hovered at around three percent. But the actual unemployment rate has reportedly been as high as 25 percent in recent years. (At the peak of the hardship caused by the collapse of the
These changes in employment, the affordability of food, and agricultural productivity have had two profound implications for the health of Cubans. First, although Cubans' average caloric intake is very high, the nutritional value of their diets is very low. According to one recent Cuban government survey, Cubans consume 3,250 calories a day on average, most of it in the form of starch and fatty pork. Obesity and diabetes are the fastest-growing causes of patient visits to government clinics and hospitals. And
The second profound effect that changes in basic living conditions in
The Castro government's largest and most extensive bilateral effort is with Hugo Chávez's leftist government in
The Cuban government benefits politically from this medical diplomacy, including by demonstrating the wisdom of its approach to public health. It is widely believed that health-care workers have become a top, if not the top, trade commodity for
MOUNTING STRAINS
For years, Cuban hospital patients have needed to provide their own syringes, bed sheets, and towels. Some say they fear getting infections while visiting clinics because of shortages of soap, disinfectants, and sterile equipment. A preventable form of cancer, cervical carcinoma, now ranks as the fourth leading cause of death for Cuban women. In most of the world, cervical cancer is on the decline thanks to annual gynecological screenings (with the Pap test) and the use of the human papillomavirus vaccine. In
Another problem in
EXODUS FEARS
According to
The only U.S. policy currently in place, however, encourages Cuban physicians to immigrate to
The Castro government, meanwhile, is in a seemingly untenable position. The two greatest achievements of the Cuban Revolution -- 100 percent literacy and quality universal health care -- depend on huge streams of government spending. If
In the long run,
For clues about what might constitute a reasonable approach that could benefit all parties, including the U.S. medical industry,
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