The April 30 issue of the journal “Science” documents both Cuban health care accomplishments and harm to Cubans’ health from the U.S. economic blockade. Authors Paul Drain and Michelle Barry, Stanford University global health experts, recommend that sanctions against Cuba be dropped.
Their article “Fifty Years of U.S. Embargo: Cuba’s Health Outcomes and Lessons,” is useful for arriving at conclusions that, while not new, do warrant fresh dissemination. Central to their critique of U.S. policies is Washington’s targeting of Cubans’ access to food and medicine.
No comprehensive overview of adverse health effects from the blockade has appeared since publication of a study in 1993 by the American Public Health Association and another in 1997 by the American Association for World Health. Summaries by Columbia University Professor Richard Garfield in the 1990’s covered similar ground highlighting the uniquely U.S. device of a unilateral trade embargo restricting food and medicine.
Tightening of sanctions in 1992 through the Cuban Democracy Act relied upon blocking foreign companies with U.S. ties from exporting food and medical supplies to Cuba. Such materials became critical to Cubans’ survival after the Soviet bloc fell. The purpose of the legislation was to finish off the newly vulnerable Cuban revolution using the prescription outlined in a State Department memo of April 6, 1960.
There, Deputy Under-Secretary of State Lester D. Mallory proposed “denying money and supplies to Cuba, to decrease monetary and real wages, to bring about hunger, desperation and overthrow of government.” Thus began, according to Cuba’s National Assembly Ricardo Alarcon, “probably the most prolonged act of genocide in history,”
Drain and Barry go on to laud Cuban emphasis on preventative health care, implementation of primary care, favorable indicators of health outcome, universal access to care, and global health outreach, all at comparatively low cost. These accomplishments lead the authors to suggesting that Cuba could teach health care to the United States.
They ask that U.S. policies be revised. “We encourage legislation that at least allows unrestricted travel to Cuba and eliminates medicine and medical supplies from the embargo. Better policy would eliminate the trade embargo.”
For a mainstream U.S. scientific journal to give voice to such information and advocacy is all to the good.
However, casting doubts on the blockade, the authors confine themselves to saying it hasn’t worked to bring about democracy. Buried in their notes, unlikely to be read, is one reference to a human rights group’s judgment as to the blockade’s illegality (among several that could have been cited) They also point out that, “Domestic and international favor for the embargo is not strong.” The understatement is clear from another note referring to repeated and overwhelming UN General Assembly rejection of the blockade.
Drain and Barry correctly offer Cuba’s high life expectancy and low infant mortality (IMR) as evidence of health care achievements. To back up their point as to Cuba’s potential educational value to the United States, they might have compared Cuba’s 2009 IMR of 4.8 with the U.S. IMR in 2005 of 6.9, 13.3 for African American infants, a rate little changed since then IMR is the number of babies from 1000 births dying during their first year.
The article cites polyclinics in Cuba as an early attempt to provide people with first contact care. That the policlinics, small group practices modeled on Soviet Union examples, didn’t work was overlooked. In response, planners instituted doctor – nurse family practice clinics, moving the polyclinics to a teaching and consulting role complementing Cuba’s network of specialty hospitals. That change of gears testifies to Cuban pragmatism.
Lastly, the authors’ reference to health outcome measures in pre-revolutionary Cuba as higher than Latin American averages overlooks urban – rural differences. Former Cuban President Fidel Castro was on target in this regard in his famous “History Will Absolve Me” speech in 1953. He spoke of “six hundred thousand Cubans without work… five hundred thousand farm laborers who work four months of the year and starve the rest.” “Ninety per cent of the children in the countryside are consumed by parasites,” he said, adding, “They will grow up with rickets.” At issue was “the mass murder of so many thousands of children who die every year from lack of facilities.”
Photo: From a PowerPoint presentation on Health in Cuba.
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