Cuban Public Health: Living the Marxist Dream

Cuban Public Health: living the Marxist Dream William Reay OMNI Behavioral Health Northcentral University How one actually carry out a work of social welfare? How one unite individ­ual endeavor with the needs of society? (Ernesto Che Guevara) 1 A ny serious discussion of com­munity-based global health care must include Cuba's public health care system. The system is a curiosity in terms of political ideol­ogy, social history, economics, design, delivery, and outcomes. Cuba is note­worthy for its (a) low infant mortal­ity, {b) low rates of birth defects, and (c) life expectancy at a level found in high-income countries. All of this has been accomplished in spite of the U.S. embargo that has been in place for 50 years and the loss of trading partners since the fall of the Soviet Union about 20 years ago. When the American Public Health Association sponsored an academic and profes­sional exchange between the United States and Cuba in November 2010, I was anxious to participate so that I could explore the public health care system, which has been a hallmark of Cuban life since the 1959 revolu­tion. I wanted to look behind the outcomes to the methods employed and examine how Cuba conceptual­izes and implements health care, especially in relation to prevention. As a psychologist and administra­tor whtl has been advocating for a public health approach to behavioral health care, I have studied integrated community-based care systems for years. Educated in both psychology and law, I am especially interested in public health systems' balance among the competing interests of personal sovereignty, personal well-being, and community needs. These interests vary substantially within and among cultures in close relation to social con­ditions, including economic factors. As a result of my trip to Cuba, my conclusions about its health care sys­tem are mixed. Their revolutionary medical system remains militarized. The methods responsible for the outstanding rates of child health indi­cators, including high rates of immu­nizations, have high costs in personal autonomy and privacy. Moreover, problems in evaluation persist at all levels of this unique, highly aligned system of government and social management. Politics and Values of the Cuban Public Health System Our delegation was joined by Cuban midlevel political and admin-10n Revolutionary Medicine (speech to the Cuban militia; Aug. 19, 1960). istrative medical personnel responsi­ble health care management, including the minister of public health. From exchanges with these individuals, it became very clear that the theoretical framework of Cuban health care remains strongly aligned with Marxist-Leninist ideology, a relationship evident at every level of the system. In other words, the choice of outcomes of interest and the methods used to achieve those outcomes are driven by the values associated with the prevailing political ideology. Moreover, these choices in health policy are sustained by the social and political structures that are pervasive in Cuban life. The Cuban health care system consists of multiple nested primary relationships, all originating at the family level. Hence, maintenance of a healthy lifestyle-behavior consis­tent with the public health care sys­tem's goals-is a duty of citizens, who are strongly influenced by the health care system at every level of personal and institutional interac­tion. The relationships among par­ents and family members, medical clinics (called polyclinics), and med­ical and political personnel are so tightly nested that citizen perspec-article is based on a presentation.at the Third Greenville Family Symposium (cosponsored by the American Orthopsychiatric Association, the Clemson University Institute on Family & Neighborhood Life, the International Family Therapy Association, and the International Society for Child Indicators) at University Center in- Greenville, SC, in April 2011. Correspondence concerning this article should be addressed to William Reay, OMNI Behavioral Health, 5115 F St., Omaha, NE 68117. Electronic mail may be sent to breay@omnibehavioralhealth.com. American Journal of Orthopsychiatry 2012, Vol. 82, No.2, 181-185 © 2012 American Orthopsychiatric Association DOl: IO.llll/j.l939-0025.2012.01152.x