Tag Archives: Health

Reordenamiento Laboral: Quién se queda, quién se va?; Labor Force Down-Sizing in Cuba’s Medical System

By Archibald Ritter

On April 7, an article in Trabajadores stated that 109,000 workers in the heath sector were to be declared redundant, generating an expected 2 billion pesos in savings in the national budget, ostensibly without damaging the quality of health care services.

The newspaper where the article was published: Trabajadores ;

The original article is  here: Trabajadores, 7 de abril de 2014, Quien se queda, quien se va

This is  an ambitions action. Indeed, it is draconian. It seems to be well beyond the legendary “shock therapies” or “structural adjustment” programs once promoted by the International Monetary Fund that have been criticized vigorously in Cuba and elsewhere in the past.  

Apparently such a down-sizing is necessary due to the over-staffing of the health care system that seems to have built up over the years. This may be the case, as Cuba continued to judge its medical performance partly on numbers of doctors and medical personnel per thousand population and number of hospital beds – quantitative success indicators that probably contributed to an excessive expansion of the system.

However, the personnel of the Ministry of Health already had been cut back significantly from their peak of 335,622  in 2008 falling to 265,617 in 2011.  This was a personnel reduction  of 23.5%, with a 37% reduction of pharmacists, a 10.5% reduction of nurses, and a 45.4% reduction in auxiliary and technical personnel.  Presumably there are many more employees in the medical system not included in the numbers of the Table, people such as custodians, secretaries, receptionists, administrators, drivers, information technologists and tradesmen, but how many of these were employed in the system is not indicated in the ONE Anuario Estadistico.

Were further cuts required after these reductions? Apparently so.

Personal facultativo, Ministerio de SaludIs the Cuban government expecting that the numerous Cuban medical personnel abroad, and mainly in Venezuela will be returning to Cuba so that cut-backs will be necessary in order to accommodate them in the medical system?  Indeed, with Venezuela teetering on the brink of serious conflagration and economic melt-down, it may well be the case that Cuban medical personnel may not be in Venezuela at current levels for much longer. Is this the expectation of the Cuban government?

It is of interest to note that as was the case with the announcement of the 500,000 target for layoffs in the state sector in 2010, , the announcement of the job cuts were published in the workers’ newspaper, Trabajadores, and the person explaining the cut-backs was a certain Rafael Guevara Chacón, an employee of the Central de Trabajadores de Cuba (CTC), the labour federation. Is this how Cuba’s labour movement defends workers’ interests?

It will not be easy determining who is and who is not redundant in the medical system. What will be the criteria for determining the redundancies? Will favoritism or a person’s political record be significant factors?  What will be the job prospects for the medical personnel that are being poured out of the educational system?

Then there is the question of where the displaced workers are to go. Some will retire, but others will have to be absorbed elsewhere in the system.

Is the cuenta-propista or self-employment sector capable of creating an additional 109,000 jobs without further liberalization of the policy environment within which it operates?

Can personnel cut-backs of this amount actually avoid damaging the medical care system?

All in all, implementing labour force cut-backs in the medical system of this magnitude will undoubtedly be a major challenge for the government.

Cuba Apr 2012 062.jpg AAAA

Maternity Hospital, Avenida G Vedado, in process of reconstruction, 2012-2014; Photo by Archibald Ritter

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Infant Mortality in Cuba: Myth and Reality

 Roberto M. Gonzalez, Department of Economics, UNC, Chapel Hill

An interesting paper on Cuba’s Infant Mortality Rate (IMR) was presented at the 2013 meetings of the Association for the Study of the Cuban Economy by Roberto M. Gonzalez, a graduate student in Economics at the University of North Carolina. The paper is especially interesting as it focuses on one important indicator of the quality of the health system, human development and socio-economic development which ostensibly has been a major achievement for Cuba. Cuba’s exceedingly low Infant Mortality Rate has been a major “logro” of the Revolution and a source o pride since the early 1960s.

Gonzalez presents information and analysis that casts some doubt on the official IMR figures. His complete argument can be seen in the Power Point presentation that he made at the ASCE meetings here: Infant Mortality in Cuba

The essence of his argument is that Late Fetal Deaths (LFDs) or deaths of fetuses weighing at least 500 grams are abnormally high in Cuba compared to other countries while Early Neonatal Deaths (ENDs) or deaths occurring in the first week of life are abnormally low. In the chart below, Cuba’s high LFD in orange and its low END in green can quickly be seen as outliers for the countries of Europe.

New Picture (12)What’s going on here? Perhaps it is reflects an erroneous mis-classification system, or purposeful mis-reporting or possibly late term and mislabeled abortions (if there is any chance of infant ill-health or a congenital health problems.)

While perhaps further work is needed to analyze this LFD-END puzzle, Gonzalez work has certainly raised serious questions about Cuba’s long-vaunted Infant Mortality Rate.

New Picture (14a )

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Publication of the Papers from the 2013 Conference of the Association for the Study of the Cuban Economy

 

The proceedings of the Association for the Study of the Cuban Economy’s 23rd Annual Meeting entitled  “Reforming Cuba?” (August 1–3, 2013) is now available. The presentations have now been published by ASCE  at http://www.ascecuba.org/.

The presentations are listed below and linked to their sources in the ASCE Web Site.

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 Preface

Panorama de las reformas económico-sociales y sus efectos en Cuba, Carmelo Mesa-Lago

Crítica a las reformas socioeconómicas raulistas, 2006–2013, Rolando H. Castañeda

Nuevo tratamiento jurídico-penal a empresarios extranjeros: ¿parte de las reformas en Cuba?, René Gómez Manzano

Reformas en Cuba: ¿La última utopía?, Emilio Morales

Potentials and Pitfalls of Cuba’s Move Toward Non-Agricultural Cooperatives, Archibald R. M. Ritter

Possible Political Transformations in Cuba in the Light of Some Theoretical and Empirically Comparative Elements, Vegard Bye

Las reformas en Cuba: qué sigue, qué cambia, qué falta, Armando Chaguaceda and Marie Laure Geoffray

Cuba: ¿Hacia dónde van las “reformas”?, María C. Werlau

Resumen de las recomendaciones del panel sobre las medidas que debe adoptar Cuba para promover el crecimiento económico y nuevas oportunidades, Lorenzo L. Pérez

Immigration and Economics: Lessons for Policy, George J. Borjas

The Problem of Labor and the Construction of Socialism in Cuba: On Contradictions in the Reform of Cuba’s Regulations for Private Labor Cooperatives, Larry Catá Backer

Possible Electoral Systems in a Democratic Cuba, Daniel Buigas

The Legal Relations Between the U.S. and Cuba, Antonio R. Zamora

Cambios en la política migratoria del Gobierno cubano: ¿Nuevas reformas?, Laritza Diversent

The Venezuela Risks for PetroCaribe and Alba Countries, Gabriel Di Bella, Rafael Romeu and Andy Wolfe

Venezuela 2013: Situación y perspectivas socioeconómicas, ajustes insuficientes, Rolando H. Castañeda

Cuba: The Impact of Venezuela, Domingo Amuchástegui

Should the U.S. Lift the Cuban Embargo? Yes; It Already Has; and It Depends!, Roger R. Betancourt

Cuba External Debt and Finance in the Context of Limited Reforms, Luis R. Luis

Cuba, the Soviet Union, and Venezuela: A Tale of Dependence and Shock, Ernesto Hernández-Catá

Competitive Solidarity and the Political Economy of Invento, Roberto I. Armengol

The Fist of Lázaro is the Fist of His Generation: Lázaro Saavedra and New Cuban Art as Dissidence, Emily Snyder

La bipolaridad de la industria de la música cubana: La concepción del bien común y el aprovechamiento del mercado global, Jesse Friedman

Biohydrogen as an Alternative Energy Source for Cuba, Melissa Barona, Margarita Giraldo and Seth Marini

Cuba’s Prospects for a Military Oligarchy, Daniel I. Pedreira

Revolutions and their Aftermaths: Part One — Argentina’s Perón and Venezuela’s Chávez, Gary H. Maybarduk

Cuba’s Economic Policies: Growth, Development or Subsistence?, Jorge A. Sanguinetty

Cuba and Venezuela: Revolution and Reform, Silvia Pedraza and Carlos A. Romero Mercado

Mercado inmobiliario en Cuba: Una apertura a medias, Emilio Morales and Joseph Scarpaci

Estonia’s Post-Soviet Agricultural Reforms: Lessons for Cuba, Mario A. González-Corzo

Cuba Today: Walking New Roads? Roberto Veiga González

From Collision to Covenant: Challenges Faced by Cuba’s Future Leaders, Lenier González Mederos

Proyecto “DLíderes”, José Luis Leyva Cruz

Notes for the Cuban Transition, Antonio Rodiles and Alexis Jardines

Economistas y politólogos, blogueros y sociólogos: ¿Y quién habla de recursos naturales? Yociel Marrero Báez

Cambio cultural y actualización económica en Cuba: internet como espacio contencioso, Soren Triff

From Nada to Nauta: Internet Access and Cyber-Activism in A Changing Cuba, Ted A. Henken and Sjamme van de Voort

Technology Domestication, Cultural Public Sphere, and Popular Music in Contemporary Cuba, Nora Gámez Torres

Internet and Society in Cuba, Emily Parker

Poverty and the Effects on Aversive Social Control, Enrique S. Pumar

Cuba’s Long Tradition of Health Care Policies: Implications for Cuba and Other Nations, Rodolfo J. Stusser

A Century of Cuban Demographic Interactions and What They May Portend for the Future, Sergio Díaz-Briquets

The Rebirth of the Cuban Paladar: Is the Third Time the Charm? Ted A. Henken

Trabajo por cuenta propia en Cuba hoy: trabas y oportunidades, Karina Gálvez Chiú

Remesas de conocimiento, Juan Antonio Blanco

Diaspora Tourism: Performance and Impact of Nonresident Nationals on Cuba’s Tourism Sector, María Dolores Espino

The Path Taken by the Pharmaceutical Association of Cuba in Exile, Juan Luis Aguiar Muxella and Luis Ernesto Mejer Sarrá

Appendix A: About the Authors

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How Cubans’ Health Improved When Their Economy Collapsed: Sometimes financial crises can force lifestyle changes for the better.

I well remember in the 1990s in Havana. Food was in short supply; meat was almost unavailable; gasoline was out of the picture; walking. cycling and the “camello” were the chief sources of transportation. The result? My Cuban friends got thin and fit.This indeed was a general phenomenon in Cuba.

But then in the last decade or so, my friends have put on weight, some in a major way. This also seems to be a general phenomenon, and Cuba has climbed back into the ranks of the countries scoring highest in the obesity rankings, with at No. 24, with 20.1% of the male population having a body-mass index of 30 or more. (The Economist, Pocket World in Figures, 2013, p.87.)

A recent study published in the BMJ Group has found that the weight losses, greater physical activity, and increased vegetable and legume consumption in this period had a variety of beneficial impacts on health, notably coronary heart disease and diabetes mortality. Then the increased food consumption (and reduced reliance on the bicycle!) during the 2000-20210 period has coincided with a worsening of some of the basic health measures.

Unfortunately the prospects for obesity and related problems may be serious for Cuba, due in part to greater food availability, and notably meat, and reduced physical activity. There also may be  a psychological factor – the urge to eat a lot when food is available, having gone through earlier periods of hunger. Cuba may now be starting to face some of the same problems as the countries where obesity has become a major challenge.

The write-up of the original medical journal article in the Atlantic is presented below. The  original article from the BMJ Group is located here:  Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends

Authors: Manuel Franco, associate professor, adjunct associate professor, visiting researcher; Usama Bilal, research assistant, visiting researcher; Pedro Orduñez, regional adviser; Mikhail Benet, professor; Alain Morejón, assistant professor; Benjamín Caballero, professor; Joan F Kennelly, research assistant professor; Richard S Cooper, professor and chair

Richard Schiffman, The Atlantic,, Apr 18 2013

When Cuba’s benefactor, the Soviet Union, closed up shop in the early 1990s, it sent the Caribbean nation into an economic tailspin from which it would not recover for over half a decade.

The biggest impact came from the loss of cheap petroleum from Russia. Gasoline quickly became unobtainable by ordinary citizens in Cuba, and mechanized agriculture and food distribution systems all but collapsed. The island’s woes were compounded by the Helms-Burton Act of 1996, which intensified the U.S. trade embargo against Cuba, preventing pharmaceuticals, manufactured goods, and food imports from entering the country. During this so-called “special period” (from 1991 to 1995), Cuba teetered on the brink of famine. Cubans survived drinking sugared water, and eating anything they could get their hands on, including domestic pets and the animals in the Havana Zoo

The economic meltdown should logically have been a public health disaster. But a new study conducted jointly by university researchers in Spain, Cuba, and the U.S. and published in the latest issue of BMJ says that the health of Cubans actually improved dramatically during the years of austerity. These surprising findings are based on nationwide statistics from the Cuban Ministry of Public Health, together with surveys conducted with about 6,000 participants in the city of Cienfuegos, on the southern coast of Cuba, between 1991 and 2011. The data showed that, during the period of the economic crisis, deaths from cardiovascular disease and adult-onset type 2 diabetes fell by a third and a half, respectively. Strokes declined more modestly, and overall mortality rates went down.

This “abrupt downward trend” in illness does not appear to be because of Cuba’s barefoot doctors and vaunted public health system, which is rated amongst the best in Latin America. The researchers say that it has more to do with simple weight loss. Cubans, who were walking and bicycling more after their public transportation system collapsed, and eating less (energy intake plunged from about 3,000 calories per day to anywhere between 1,400 and 2,400, and protein consumption dropped by 40 percent). They lost an average of 12 pounds.

Bicycle Parking Lot, Havana

Hydroponic Urban Agriculture, Havana

It wasn’t only the amount of food that Cubans ate that changed, but also what they ate. They became virtual vegans overnight, as meat and dairy products all but vanished from the marketplace. People were forced to depend on what they could grow, catch, and pick for themselves– including lots of high-fiber fresh produce, and fruits, added to the increasingly hard-to-come-by staples of beans, corn, and rice. Moreover, with petroleum and petroleum-based agro-chemicals unavailable, Cuba “went green,” becoming the first nation to successfully experiment on a large scale with low-input sustainable agriculture techniques. Farmers returned to the machetes and oxen-drawn plows of their ancestors, and hundreds of urban community gardens (the latest rage in America’s cities) flourished.

“If we hadn’t gone organic, we’d have starved!” said Miguel Salcines Lopez in the journal Southern Spaces. Salcines is an agricultural scientist who founded “Vívero Alamar,” one of Cuba’s best known organopónicos, or urban farms, in vacant lots in Havana.

During the special period, expensive habits like smoking and most likely also alcohol consumption were reduced, albeit briefly. This enforced fitness regime lasted only until the Cuban economy began to recover in the second half of the 1990s. At that point, physical activity levels began to fall off, and calorie intake surged. Eventually people in Cuba were eating even more than they had before the crash. The researchers report that “by 2011, the Cuban population has regained enough weight to almost triple the obesity rates of 1995.”

Not surprisingly, the diseases of affluence made a comeback as well. Diabetes increased dramatically, and declines in cardiovascular disease slowed to their sluggish pre-1991 levels. (Heart disease did decline slightly in the 1980s due to improved detection and treatments.) By 2002, “mortality rates returned to the pre-crisis pattern,” according to the authors of the study. Cancer deaths, which fell in the years after the crash, also started inching up after the recovery, rising 5.4 percent from 1996 to 2010.

While the study’s author’s are cautious about attributing all of these changes in disease rates exclusively to changes in weight, Professor Walter Willett, of the Harvard School of Public Health, Boston wrote in an editorial that the study does provide “powerful evidence [that] a reduction in overweight and obesity would have major population-wide benefits.”

The findings have special relevance to the U.S., which is currently in the midst of a type 2 diabetes epidemic. Disease rates more than doubled from 1963 to 2005, and continue to rise precipitously. Diabetes and its attendant complications have been called one of “the main drivers” of rising health care costs in the U.S. by a report which was published last month by the American Diabetes Association (ADA). “Recent estimates project that as many as one in three American adults will have diabetes in 2050,” according to Robert Ratner, the chief scientific and medical officer of the ADA.

Cardiovascular disease is statistically an even bigger scourge. This illness, which was relatively rare at the turn of the twentieth century, has become the leading cause of mortality for Americans, responsible for over a third of all deaths. Heart disease is associated with our increasingly sedentary lifestyles, obesity, and artery-clogging diets.

The Cuban experience suggests that to seriously make a dent in these problems, we’ll have to change the lifestyle that helps to cause them. The study’s authors recommend “educational efforts, redesign of built environments to promote physical activity, changes in food systems, restrictions on aggressive promotion of unhealthy drinks and foods to children, and economic strategies such as taxation.”

But they also acknowledge that the changes that they are calling for are tough to engineer at the government level: “So far, no country or regional population has successfully reduced the distribution of body mass index or reduced the prevalence of obesity through public health campaigns or targeted treatment programs.”

So where does that leave us? If the United States want to stem the rise of diabetes and heart disease, either we get serious about finding ways for to become more physically active and to eat fewer empty calories — or we wait for economic collapse to do that work for us.

Fig 2 Distributions of body mass index as recorded by national surveys conducted in Cienfuegos in 1991, 1995, 2001, and 2010

Fig 4 Obesity prevalence and coronary heart disease, cancer and stroke mortality in Cuba (1980-2010). Red shaded area=period of economic crisis; blue shaded area=period of economic recovery; CHD=coronary heart disease. CHD mortality decreased by 0.50% per year from 1980 to 1996, 6.48% per year from 1996 to 2002, and 1.42% per year from 2002 to 2010. Cancer mortality decreased by 0.12% per year from 1980 to 1996, but increased by 0.47% per year from 1996 to 2010. Stroke mortality fell by 0.39% per year from 1980 to 2000, 5.03% per year from 2000 to 2004, and 0.01% per year from 2004 to 2010

Fig 1 Physical activity, dietary energy intake, and smoking in Cuba, 1980-2010. Red shaded area=period of economic crisis; blue shaded area=period of economic recovery. Physical activity data recorded in 1987, 1988, and 1994 obtained from Havana surveys; data recorded in 1995, 2001, and 2010 come from national surveys. *1 kcal=0.00418 MJ

Fig 3 Prevalence of obesity and diabetes, incidence, and mortality in Cuba, 1980-2010. Red shaded area=period of economic crisis; blue shaded area=period of economic recovery. Diabetes prevalence increased by 2.93% per year from 1980 to 1997, and 6.27% per year from 1997 to 2010. Diabetes mortality increased by 5.85% per year from 1980 to 1989, but fell by 0.68% per year from 1989 to 1996 and 13.95% per year from 1996 to 2002, before increasing by 3.31% per year from 2002 to 2010

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Carmelo Mesa-Lago, “Sistemas de protección social en América Latina y el Caribe: Cuba”

Carmelo Mesa-Lago, Documento de Proyecto,  CEPAL, Santiago Chile, 2012

Ensayo original:  Mesa-Lago, Cuba Proteccion Social CEPAL-13

Carmelo Mesa-Lago

Desde el inicio de la República en 1902 hasta 1958 el Estado introdujo sistemas públicos de educación y de salud gratuitos; el primero complementado por escuelas privadas y el segundo por una red de cooperativas, mutuales y clínicas privadas, esquemas de mejor calidad que los sistemas públicos, mientras que el acceso y la calidad de los últimos era muy inferior en el campo que en la capital y otras ciudades. La Constitución de 1940 y la legislación laboral y de seguridad social estaban entre las más avanzadas de América Latina pero, a diferencia del resto de la región (salvo Uruguay), no se creó un seguro nacional de salud, si bien el inusual desarrollo de cooperativas, mutuales y clínicas urbanas en parte  alivió ese vacío. En 1957 el desempleo abierto promediaba el 16% más el 14% de subempleo  (30% en total), bajaba durante la cosecha azucarera que proveía el 25% del empleo y se  duplicaba en el resto del año. Tampoco se creó un seguro de desempleo que era lo usual en la región. Se estableció gradualmente un sistema de pensiones de seguro social que cubría alrededor del 62% de la PEA pero segmentado en 54 esquemas separados, con amplias e injustificadas diferencias entre ellos. No existían programas integrados a nivel nacional de asistencia social ni de viviendas estatales o subsidiadas. Tal como ocurría en el resto de la región, no había estadísticas de incidencia de pobreza y de desigualdad del ingreso, pero la escasa información disponible indicaba que ambas eran substanciales. No obstante, en 1958 Cuba se ordenaba entre el primero y el quinto puesto de la región en sus indicadores sociales nacionales, pero con considerable desigualdad especialmente entre las zonas urbanas y rurales. Por ejemplo, la tasa de analfabetismo nacional era del 23%, pero en las ciudades   41,7% en el campo del 41,7%.
En el período de 1959-1989, la revolución logró avances muy notables en la protección social. El Estado dio prioridad y asignó cuantiosos recursos fiscales para: 1) promover el pleno empleo; 2) reducir la desigualdad en el ingreso mediante la expropiación de la riqueza y la disminución de las diferencias salariales en el empleo que era básicamente público; 3) universalizar los servicios gratuitos de educación y de salud que redujeron de forma substancial las disparidades en el acceso y calidad de los servicios sociales entre la ciudad y el campo; 4) lanzar una campaña de alfabetización, graduar masivamente maestros y médicos, y construir escuelas y establecimientos de salud; 5) acelerar la incorporación de la mujer a la fuerza laboral con políticas de educación y guarderías infantiles;  6) expandir la cobertura y monto de las pensiones de seguro social, financiadas por las empresas estatales y el fisco, sin cotización de los trabajadores; 7) crear un programa de asistencia social nacional y municipal; y 8) convertir a la gran mayoría de la población en propietaria de las viviendas que tenían arrendadas. El gobierno expropió todas las instalaciones de educación y salud privadas y cooperativas, además absorbió, unificó y homologó los 54 esquemas de pensiones. La construcción y mantenimiento de las viviendas, fundamentalmente a cargo del Estado, fue insuficiente y aumentó el déficit habitacional. Coadyuvó al desarrollo social la ayuda de 65.000 millones de dólares por la Unión Soviética en 1960-1990 (sin contar otros países socialistas), 60,5% en donaciones y subsidios de precios más 39,5% en préstamos que virtualmente no fueron pagados. Aunque dicha ayuda no se dio al sector social, liberó recursos internos para financiar la política del gobierno en este campo. En 1989 Cuba se colocaba a la cabeza de América Latina en la gran mayoría de los indicadores sociales.
El colapso de la Unión Soviética provocó en 1990-1994 una crisis económica muy severa: la caída 35% del PIB, la virtual paralización de la industria y de la agricultura por falta de combustible, insumos y piezas de repuesto, y una mengua drástica en las exportaciones e importaciones (incluyendo insumos para servicios sociales). A la crisis contribuyó el “Proceso de Rectificación de Errores”2, y la incapacidad del modelo de desarrollo para resolver los problemas estructurales, generar un crecimiento económico sostenible, expandir las exportaciones y substituir importaciones. Además, la política social adolecía de fallas: el pleno empleo se logró en parte creando empleo estatal innecesario lo que afectó a la productividad; el excesivo igualitarismo y énfasis cíclico en incentivos “morales” (no económicos) indujo una caída en el esfuerzo laboral y alto ausentismo; y el alto costo de los programas sociales se agravó por el envejecimiento demográfico. A pesar del esfuerzo del gobierno para proteger los programas sociales, casi todos sus indicadores se deterioraron y en 1993 Cuba había descendido en su ordenamiento social en la región.
Las modestas reformas orientadas al mercado en 1993-1996 lograron a partir de 1995 una recuperación económica parcial, pero ocurrió una desaceleración en 2001-2003 en gran  medida por la virtual paralización de las reformas y la “Batalla de Ideas”. Este programa, facilitado por la ayuda económica venezolana y centrado en la lucha ideológica incluyó varias políticas: revirtió las reformas de los años noventa, re-acentuó el centralismo, creó una cuenta única de divisas y CUC en el Banco Central de Cuba (BCC), puso énfasis de nuevo en el igualitarismo y la movilización laboral, redujo el trabajo por cuenta propia, intentó universalizar la educación superior, continuó expandiendo el empleo estatal innecesario, y acrecentó el gasto social haciéndolo insostenible. A partir de 2004, el PIB  creció con rapidez y alcanzó una cima en 2006, debido a la ayuda económica de la República Bolivariana de Venezuela, la expansión de los servicios sociales y un cambio en la  metodología internacional para calcular el PIB3. La crisis global de 2007-2009 y los problemas que arrastraba el modelo de desarrollo cubano indujeron otra desaceleración en la tasa del PIB. Aún con oscilaciones, la recuperación en 1995-2006 ayudó a mejorar los indicadores sociales y la mayoría sobrepasó los niveles pre-crisis de 1989, aunque la pobreza y la desigualdad aumentaron. Desde 2007 ocurrió otra regresión en dichos indicadores por la crisis global y las necesarias “reformas estructurales” del Presidente Raúl Castro para corregir los problemas económico-sociales del país, aprobadas por el VI Congreso del Partido Comunista de Cuba (PCC) en 2011 y extendidas en 2012. Este capítulo se concentra en el período comprendido entre 2007 y2012, describe las reformas por sector social y evalúa sus efectos.

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Castrocare in Crisis: Will Lifting the Embargo on Cuba Make Things Worse?

The original complete essay is located here:  Castrocare in Crisis

Laurie Garrett; Foreign Policy, July-August, 2010

Hospital Hermanos Ameijeiras

 Cuba is a Third World country that aspires to First World medicine and health. Its health-care system is not only a national public good but also a vital export commodity. Under the Castro brothers’ rule, Cubans’ average life expectancy has increased from 58 years (in 1950) to 77 years (in 2009), giving Cuba the world’s 55th-highest life expectancy ranking, only six places behind the United States. According to the World Health Organization (WHO), Cuba has the second-lowest child mortality rate in the Americas (the United States places third) and the lowest per capita HIV/AIDS prevalence. Fifty years ago, the major causes of disease and death in Cuba were tropical and mosquito-borne microbes. Today, Cuba’s major health challenges mirror those of the United States: cancer, cardiovascular disease, obesity, diabetes, and other chronic ailments related to aging, tobacco use, and excessive fat consumption.

By any measure, these achievements are laudable. But they have come at tremendous financial and social cost. The Cuban government’s 2008 budget of $46.2 billion allotted $7.2 billion (about 16 percent) to direct health-care spending. Only Cuba’s expenditures for education exceeded those for health, and Cuba’s health costs are soaring as its aging population requires increasingly expensive chronic care.

Cuba’s economic situation has been dire since 1989, when the country lost its Soviet benefactors and its economy experienced a 35 percent contraction. Today, Cuba’s major industries — tourism, nickel mining, tobacco and rum production, and health care — are fragile. Cubans blame the long-standing U.S. trade embargo for some of these strains and are wildly optimistic about the transformations that will come once the embargo is lifted.

Overlooked in these dreamy discussions of lifestyle improvements, however, is that Cuba’s health-care industry will likely be radically affected by any serious easing in trade and travel restrictions between the United States and Cuba. If policymakers on both sides of the Florida Straits do not take great care, the tiny Caribbean nation could swiftly be robbed of its greatest triumph. First, its public health network could be devastated by an exodus of thousands of well-trained Cuban physicians and nurses. Second, for-profit U.S. companies could transform the remaining health-care system into a prime destination for medical tourism from abroad. The very strategies that the Cuban government has employed to develop its system into a major success story have rendered it ripe for the plucking by the U.S. medical industry and by foreigners eager for affordable, elective surgeries in a sunny climate. In short, although the U.S. embargo strains Cuba’s health-care system and its overall economy, it may be the better of two bad options.

…..

…..

Conclusion

In the long run, Cuba will need to develop a taxable economic base to generate government revenues — which would mean inviting foreign investment and generating serious employment opportunities. The onus is on the Castro government to demonstrate how the regime could adapt to the easing or lifting of the U.S. embargo. Certainly, Cuban leaders already know that their health triumphs would be at risk.

The United States, too, has tough responsibilities. How the U.S. government handles its side of the post-embargo transition will have profound ramifications for the people of Cuba. The United States could allow the marketplace to dictate events, resulting in thousands of talented professionals leaving Cuba and dozens of U.S. companies building a vast offshore for-profit empire of medical centers along Cuba’s beaches. But it could and should temper the market’s forces by enacting regulations and creating incentives that would bring a rational balance to the situation.

For clues about what might constitute a reasonable approach that could benefit all parties, including the U.S. medical industry, Washington should study the 2003 Commonwealth Code of Practice for the International Recruitment of Health Workers. The health ministers of the Commonwealth of Nations forged this agreement after the revelation that the United Kingdom’s National Health Service had hired third-party recruiters to lure to the country hundreds of doctors and nurses from poor African, Asian, and Caribbean countries of the Commonwealth, including those ravaged by HIV/AIDS and tuberculosis. In some cases, the recruiters managed to persuade as many as 300 health-care workers to leave every day. Although the agreement is imperfect, it has reduced abuses and compensated those countries whose personnel were poached.

Cuba’s five decades of public achievement in the health-care sector have resulted in a unique cradle-to-grave community-based approach to preventing illness, disease, and death. No other socialist society has ever equaled Cuba in improving the health of its people. Moreover, Cuba has exported health care to poor nations the world over. In its purest form, Cuba offers an inspiring, standard-setting vision of government responsibility for the health of its people. It would be a shame if the normalization of relations between the United States and Cuba killed that vision.

 

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Cuban health care: Nip and tuck in

Cuban health care: Nip and tuck in

Nov 17th 2012, The Economist

SET in a former naval academy overlooking the Florida Straits, the Latin American School of Medicine (ELAM) is supposed to symbolise Cuba’s generosity. Founded by Fidel Castro in 1999, the school’s mission was to provide free training to medical students from all over the world. But these days, visiting foreign dignitaries are given a sales pitch along with their campus tours.

As part of President Raúl Castro’s attempt to stem his brother’s spending, many nations that send students to the school are now expected to pay. Just how much isn’t entirely clear, but the rates are high enough to cause embarrassment to some of the customers. John Mahama, Ghana’s new president and a staunch ally of Cuba, has been obliged to defend what looks like a pricey deal he signed with ELAM as vice-president.

Cuba’s government has never been coy about the sale of its medical services abroad. Official figures show that professionals working overseas—largely in medicine—bring in around $6 billion a year (though the doctors themselves receive only a small fraction of the revenue). Most of that comes from Venezuela, which trades subsidised oil for legions of Cuban health workers. But reports in Namibia suggest that prices for services there are rising, too.

In Cuba itself, meanwhile, private medicine is readily available to paying foreigners and well-connected locals. The two best hospitals in Havana, Cira García and CIMEX, are run for profit. Both are far better than normal state hospitals, where patients are often obliged to bring their own sheets and food.

But health care is now also available on the buoyant black market. A current vogue for breast implants is providing extra income to many surgeons (whose state salary is around $20 a month). The director of one of Havana’s main hospitals was recently detained for running a private health network on the side. Alongside the new restaurants that are opening in the capital, as a result of Raúl Castro’s partial easing of economic restrictions, doctors are now less shy about selling their services. One private dental practice in the Vedado district is notably well-equipped with a snazzy dentist’s chair and implements.

These medical entrepreneurs run the risk of prosecution. If caught, they may be tempted to argue that they are simply following the government’s example.

Cira Garcia (Hard-Currency) Hospital, Mainly for Foreigners

Latin American School of Medicine

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Cuba Closes Hospitals and medical Facilities as Health Budgets Shrink,

Cuba closes hospitals as health budgets shrink,  from the Vancouver Sun, Associated Press, Published: October 10, 2012.

Maternity Hospital, Linea and Avenida “G” Closed for Repairs? “

Photo by Arch Ritter, April 2012

HAVANA — Cuba shuttered hundreds of medical facilities last year, including 54 hospitals, as the country reorganizes its health care sector.

The number of medical installations nationwide fell from 13,203 in 2010 to 12,738 last year, a decline of 3.5 percent, according to figures posted online in recent days by the National Office of Statistics. The reductions included everything from general hospitals to family clinics, the small medical outposts that are ubiquitous across the island.

Cuba is proud of the universal, free health system installed after Fidel Castro’s 1959 revolution, but his younger brother and successor Raul Castro has stressed that medical care must be more efficient and less wasteful.

Health care budgets have been shrinking in recent years under Raul Castro, though authorities exhort doctors to simply do more with less and promise there will be no elimination of services.

Reports in state media have recently highlighted examples of waste, such as clinics with more drivers than ambulances and clinics with more workers than beds.

The government also launched a campaign called “It’s free, but it costs,” to raise islanders’ awareness about how much the government spends providing health care.

The report from the Statistics Office reported an uptick in the number of doctors, from around 76,500 in 2010 to nearly 78,700 last year. Cuba already had one of the world’s highest doctor-patient ratios.

Over the same period, technicians and support staff dropped sharply from 87,600 to 76,000.

Raul Castro has said the country must slash inflated payrolls dramatically as part of his five-year plan to overhaul the economy.

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Al Jazeera on “The Truths and Tales of Cuban Healthcare”

The full article is available here:The Truths and Tales of Cuban Healthcare  and here;  http://www.aljazeera.com/indepth/features/2012/06/201265115527622647.html. The Introduction and an excerpt are reproduced below.

The state-run system has been praised, but many specialists now fear they are falling behind international standards.

Lucia Newman  Last Modified: 18 Jun 2012 08:30

If there is one thing for which Cuba has received praise over the years, it is the Communist government’s state-run healthcare system. Much of this praise is well-deserved. Despite its scarce resources, Cuba has one of the world’s lowest infant mortality rates – just slightly lower than that of the US. Life expectancy is 77.5 years, one of the world’s highest. And until not so long ago, there was one doctor for every 170 citizens – the highest patient-per-doctor ratio in the world.

Of course, the government can afford so many doctors because they are paid extremely low salaries by international standards. The average is between $30 and $50 per month.

And the benefits of this healthcare have not only been felt by Cubans.

Under Fidel Castro, the former Cuban president, hundreds of child victims of the Chernobyl nuclear disaster, left without proper medical attention after the collapse of the Soviet Union, were invited to Cuba. A hospital was constructed to treat them while they and their families set up temporary residence in Tarara, a beautiful seaside neighborhood near Havana. Many remain there today.

Decline

By the time I moved to Cuba in 1997, there were serious shortages of medicine – from simple aspirin to more badly needed drugs.

Ironically, many medicines that cannot be found at a pharmacy are easily bought on the black market. Some doctors, nurses and cleaning staff smuggle the medicine out of the hospitals in a bid to make extra cash.

Although medical attention remains free, many patients did and still do bring their doctors food, money or other gifts to get to the front of the queue or to guarantee an appointment for an X-ray, blood test or operation.  If you do not have a contact or money to pay under the table, the waiting time for all but emergency procedures can be ridiculously long.

Many Cubans complain that top-level government and Communist Party officials have access to VIP health treatment, while ordinary people must queue from dawn for a routine test, with no guarantee that the allotted numbers will not run out before it is their turn. And while the preventative healthcare system works well for children, women over the age of 40 are being shortchanged because yearly mammograms are not offered to the population at large.

I saw many hospitals where there was often no running water, the toilets did not flush, and the risk of infections – by the hospital’s own admission – was extremely high.

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Centro de Estudios de la Economía Cubana (CEEC)

By Arch Ritter

Centro de Estudios de la Economía Cubana (CEEC)

The University of Havana’s Centro de Estudios de la Economia Cubana has made itself the foremost research institution on the Cuban economy since its establishment in 1989.  Its faculty includes many of the best-known analysts on the Cuban economy, including both senior and newer faculty members. The work of the Cuban Economy Team is especially impressive and is certainly worth careful study by anyone interested in Cuba. I have often thought that Cuba would benefit immensely if some of the members of CEEC were in key Cabinet positions in the Government of Cuba responsible for the management of the economy.  I expect that this in fact will happen before too long!

Cuban Economy Team: Dr. Juan Triana Cordoví, Dr. Omar Everleny Pérez (Director), Dr. Armando Nova González, Dr. Hiram Marquetti Nodarse, Dr. Jorge Mario Sánchez Egozcue, Dr. Pavel Vidal Alejandro, Ms. Betsy Anaya, Ms. CamilaPiñeiro Harnecker, Ms. Ricardo Torres Pérez and Lic. Saira Pons Pérez

Enterprise Management Team: Dr. Orlando W. Gutierréz Castillo, Dr. Humberto Blanco Rosales, Dr. Rosendo Morales González, Dr. Jorge Ricardo Ramírez, Dra. Aleida Gonzalez-Cueto, Dra. Dayma Echevarría León, Dra. Ileana Díaz Fernández, Ms. Mercedes González Sánchez, Ms. Maria Isabel Suárez González,  Lic. Dayrelis Ojeda Suris and Lic. Mariuska Cancio  Fonseca

The CEEC publishes a number of “Boletínes” each year that usually include valuable analyses of various aspects of Cuba’s economy and economic policy. Here are the Tables of Contents of the last three issues. The “Boletínes” are hyper-linked to the CEEC Web Site and some of the essays are linked to the PDF files for rapid access.

Boletín Agosto 2011

El sistema de gestion y direccion de la economia hoy. Ileana Diaz,  Dra.Ileana Diaz

Experiencias noruegas relevantes para la agricultura cubana, Dr. Anicia Garcia

La propiedad en la economia cubana. Armando Nova,  Dr.Armando Nova

Los sistemas de direccion  de la economia  1961- 1975,  Dra.Ileana Diaz

Turismo de salud en Cuba. David Pajon Dr. David Pajon

Boletín Abril-Agosto 2010

Competitividad e innovacion, donde esta Cuba. Ileana Diaz, Dr. Ileana Díaz

El impacto del postgrado en la educacion superior Cuba- Venezuela. Rosendo Morales Dr. Rosendo Morales

El mercado y el estado, dos partes que forman un todo. Armando Nova, Dr. Armando Nova González

Entre el ajuste fiscal y los cambios estructurales, se extiende el cuentapropismo, Dr. Pavel Vidal y Dr. Omar Everleny Pérez

Fuerzas favorables y restrictivas a la dirección estratégica de la empresa. Dayrelis Ojeda y Humberto Blanco Lic. Dayrelis Ojeda y Dr. Humber

Boletin Enero-Mayo 2010

El mercado libre agropecuario en 2009. Armando Nova, Dr. Armando Nova González

El sector energetico cubano entre 2005 y 2009. Ricardo Torres_0 Ms. Ricardo Torres Pérez

La política fiscal actual. Pavel Vidal_0 Dr. Pavel Vidal Alejandro

Estrategia. Mito o realidad. Ileana Diaz y Roberto Cartaya_0 Dr. Ileana Díaz y Dr. Roberto Cartaya

La producción agricola y ganadera en 2009. Armando Nova_0 Dr. Armando Nova González

La universidad, la economía y el desarrollo. Juan Triana_0 Dr. Juan Triana Cordoví

Los cambios estructurales e institucionales. Pavel Vidal_0,  Dr. Pavel Vidal Alejandro

Universidad de la Habana, “Alma Mater”

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