Cuba has long had a nearly identical life expectancy to the United States, despite widespread poverty. The humanitarian-physician Paul Farmer notes in his book Pathologies of Power that there’s a saying in Cuba: “We live like poor people, but we die like rich people.” Farmer also notes that the rate of infant mortality in Cuba has been lower than in the Boston neighborhood of his own prestigious hospital, Harvard’s Brigham and Women’s.
All of this despite Cuba spending just $813 per person annually on health care compared with America’s $9,403.
In Cuba, health care is protected under the constitution as a fundamental human right. As a poor country, Cuba can’t afford to equivocate and waste money upholding that. This pressure seems to have created efficiency. Instead of pouring money into advanced medical technology, the system is forced to keep people healthy.
It’s largely done, as the BBC has reported, through an innovative approach to primary care. Family doctors work in clinics and care for everyone in the surrounding neighborhood. At least once a year, the doctor knocks on your front door (or elsewhere, if you prefer) for a check-up. More than the standard American ritual of listening to your heart and lungs and asking if you’ve noticed any blood coming out of you abnormally, these check-ups involve extensive questions about jobs and social lives and environment—information that’s aided by being right there in a person’s home.
Then the doctors put patients into risk categories and determine how often they need to be seen in the future. Unlike the often fragmented U.S. system where people bounce around between specialists and hospitals, Cuba fosters a holistic approach centered around on a relationship with a primary-care physician. Taxpayer investment in education about smoking, eating, and exercising comes directly from these family doctors—who people trust, and who can tailor recommendations.
The system requires around twice as many primary-care doctors per capita as we have in the U.S., made possible because the country also invested in medical education, creating in 1998 what U.N. Secretary General Ban Ki-moon called “the world’s most advanced medical school.” Cuba has become known for training not just domestic doctors, but those from around the world—and sending its doctors to help other, wealthier countries when needed. During the recent Ebola crisis in Sierra Leone, more than 100 Cuban doctors and nurses were at the front lines.
Castro justified sending so much support with a brutally holistic understanding of disease as a global phenomenon. He wrote at the time: “By completing this task with maximum planning and efficiency, our people and sister peoples of the Caribbean and Latin America will be protected, preventing expansion of the epidemic, which has unfortunately already been introduced, and could spread, in the United States, which maintains many personal ties and interactions with the rest of the world.”