Cuban Public Health: A Model for the U.S.

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Layout. Crucial statisticsHealth framework performanceRecent history and association of Cuban wellbeing carePublic wellbeing organizationExamplesLessons for the U.S.?. . Cuba is a Country of Ironies. The Irony of Cuban Health Care.

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Cuban Public Health: A Model for the U.S.? Marc Schenker M.D., M.P.H.

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Outline Vital measurements Health framework execution Recent history and association of Cuban social insurance Public wellbeing association Examples Lessons for the U.S.?

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Cuba is a Country of Ironies

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The Irony of Cuban Health Care "Since Cuba has so couple of assets, anticipation has turned into the main moderate method for keeping its populace sound."

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Vital Statistics

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Life Expectancy* in 2000 *years

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Life Expectancy at Birth Source: PAHO 2000

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Infant Mortality* in 2000 *per 1,000 live births

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Infant Mortality Rate Source: PAHO 2000

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Probability of Dying (per 1000), 1999 Source: World Health Organization, 2000.

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GDP per Capita $1000/capita

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National Health Expenditures per Capita (US $) Source: Pan American Health Organization, 1998.

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Health Expenditure as % of GDP

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Health Expenditures as % of National Budget in Cuba, 1990-1997 Source: Center for Financial Research of the Ministry of Finance, Cuba, 1998.

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Physicians per 10,000 Population

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Number of People per Physician Source: PAHO 2000

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Number of specialists per 100,000 populace Cuba 56 United States 51 Japan 31 Sweden 29 Germany 13 China 10 Columbia 7 United Kingdom 6 South Africa 6 Philippines 1.5 Kenya 0.6 Tanzania 0.3 Bulletin of the American College of Surgeons, 1987 J. Perez, individual correspondence, 2000

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Health System Performance

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World Health Report of Health System Performance, 2000 Ranking of 191 nations utilizing composite file 25% level of wellbeing 25% distribution of wellbeing 12.5% level of responsiveness 12.5% distribution of responsiveness 25% financial commitment

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World Health Report of Health System Performance, 2000 Cuba Ranking 33rd Disability balanced life years 41st Distribution of human services 116th Level of responsiveness 99th Distribution of responsiveness 24th Fairness in monetary commitment 40th Overall objective achievement 39th Overall execution Costa Rica, USA, Slovenia ranker higher Brunei, New Zealand, Bahrain positioned lower

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Health Systems Performance Rankings of 191 part states Source: World Health Organization, 2000.

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Recent History and Organization of Cuban Health Care

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Recent Cuban History 1959 Cuban transformation 1962 Cuban rocket emergency 1960s-70s Cuban furnished intercessions Africa, Latin America 1989 Collapse of Communism, lessened Soviet subsidies 1990-95 "Special period" real grimness, 35% drop GDP, 75% decline in exchange 1993 Cubans permitted to have U.S. $ 1996 Helms/Burton Act fixes ban

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Cuban Healthcare History 1959 3000 specialists leave island 1960s Ministry of Health (MINSAP) extended Socialist human services framework Distribution of human services crosswise over Cuba Network of polyclinics Hospital beds (Havana 62% - >38%) National Immunization Program Medical schools expanded from 1 to 4 2000 graduates for every year 1984 Integral General Medicine program

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Physician Migration "Doctor relocation from creating to created nations has been censured as a backward appropriation paid for by poor countries that take care of the expenses of restorative training while rich nations receive the rewards. The way that the most intelligent personalities are more inclined to relocate makes this mind deplete much more uncalled for." Diego Rosselli, Andres Otero, and Giovanni Maza, Universidad Javeriana Medical School, Colombia Source: Medical Education 2001;35:809-810.

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Physician Migration: Colombia In January 2000, there were 2515 Colombian-prepared doctors authorized to hone in the United States. This is identical to 6% of the national workforce. As per a learn at Javeriana University Medical School, the U.S. vagrants had higher evaluations than the individuals who remained in Colombia. Sources: American Medical Association; Rosselli et al., 2001.

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Cuba and the Export of Physicians Cuba is home to 60,000 specialists – similar to Canada, which has 3 times the populace Many of these specialists are allocated to work in creating nations Source: Canadian Medical Association Journal 2001; 164(10): 1477.

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Accomplishments Abroad Over 20,000 Cuban specialists have been sent to 20 nations to help defeat doctor deficiencies. At the point when Hurricane Mitch struck Honduras in 1998, somewhere in the range of 120 Cuban doctors were sent, and have since treated 1.2 million patients. 800 Cuban specialists at present work in Haiti. Cuban specialists have made an AIDS-aversion program in Uganda that the UN considers a model. Source: Canadian Medical Association Journal 2001; 164(10): 1477. Yan E. Castro Makes a Dream Offer. Newsday 28 February 2001.

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Medical Education and Diplomacy 3,400 medicinal understudies from 23 Latin American, African, and Caribbean nations are being prepared in Cuba, to Cuba's detriment In 2001, 8 American understudies, all from low-wage minority families, started their free therapeutic training in Cuba, on the condition that they come back to their groups for administration. Fidel Castro has said that up to 500 American therapeutic understudies may take action accordingly. Source: Canadian Medical Association Journal , 2001, 164(10): 1477.

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Public Health in Cuba

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Aspects of Public Health in Cuba Highly coordinated with remedial pharmaceutical Polyclinic groups of essential care specialists, dental practitioners, medical attendants Provide wellbeing instruction, preventive care Health laborers live in the group Physicians required to see each patient consistently Records of preventive administrations Prenatal, vaccination, tumor screening, and so on. Forceful follow-up of missed arrangements Vaccination rates 99+% Community support of general wellbeing Neighborhood Committees for Defense of Revolution, Cuban Federation of Women, Circulos de Abuelos Surveillance information to region, state

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Examples of Cuban Public Health, Infectious illnesses Incidence of immunization preventable irresistible maladies lower than in some other country at Cuba's level of monetary advancement. Vaccination rates in the vicinity of 99% and 100% Compliance by routine epidemiologic reconnaissance at the area level (e.g. CDR)

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Mortality Rates for Infectious Diseases Deaths per 100,000

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Examples of Cuban Public Health, Geriatric Care Geriatric turn amid residency preparing. Essential care doctors who choose to increase extra preparing in geriatrics give benefits in system of maturity homes. "Grandparents' circles" ( circulos de abuelos ) give neighborhood-based care and support.

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Examples of Cuban Public Health, Medical Surveillance Data on intense and constant sicknesses go from family doctors to civil, commonplace and national levels. ID of pestilences Neuropathy between 1991-1993 Dengue

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Pesticide Spraying for Mosquitos

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Examples of Cuban Public Health, AIDS Initial isolate of HIV-positive patients Started with HIV+ troopers coming back from Africa Compulsory isolate lifted, HIV asylums got to be distinctly deliberate Sanitariums in 13/14 regions 70-80% recently analyzed pick walking treatment Epidemic aided by isolate, travel confinements. Most minimal HIV rate in half of the globe Active screening, 2 million yearly HIV tests "Jinaterismo" (prostitution) raises many issues

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HIV in Haiti and in Cuba Cuba: Haiti: Total population: People living with AIDS (1999 est.) : AIDS passings (1999 est.) : HIV/AIDS grown-up predominance rate (1999 est.) : 11 million 7 million 1,950 210,000 120 23,000 0.03 % 5.17 % Source: CIA World Factbook, 2001.

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Cuban Public Health: A Model for the U.S.? Cuba is a communist framework, not transferable to the U.S. No private medicinal services. Observation includes meddlesome social establishments, e.g. CDR Public wellbeing may include "coercive" strategies, e.g. Helps isolate, pesticide splashing NO

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Cuban Public Health: A Model for the U.S.? There is no inherent purpose behind the division of treatment and preventive (general wellbeing) benefits in the U.S. Coordinated essential care is a financially savvy display (in the event that we can arrive) Prioritizing wellbeing assets to accomplish social targets (e.g. dispose of wellbeing disparaties) is powerful Improving observation frameworks at the essential care level is vital and conceivable NOWEVER

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The U.S.: Defending the Embargo "There is an expansive assortment of falsehood and through and through disinformation about the current situation with social insurance in Cuba… The Cuban Government's consider strategy incorporates denying its kin of fundamental therapeutic needs, while effectively building up a shut, parallel medicinal services framework for the Communist Party first class, remote 'wellbeing sightseers,' and other people who can pay for administrations in hard money." U.S. Division of State, Press Statement, 1997

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The Ultimate Public Health Irony in Cuba

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The End