Reading press accounts over the past week in CNN, NPR, and The Washington Post on Cuba's response to COVID-19 ignores recent history. Havana is trying to position itself, once again, as a “safe” destination for international tourists in the time of COVID-19. Thousands of tourists were left in the lurch last year in Cuba, and the conditions maybe recreated with another round of misleading propaganda in 2021.
In March 2020 Havana claimed COVID-19 didn't replicate at high temperatures
Cuba has a population of 11.3 million and according to data they've provided there have been 425 deaths due to COVID-19 in the island. Meanwhile the Dominican Republic has a population of 10.9 million and according to data provided by official channels there have been 3,330 deaths due to COVID-19 on that island. Cuba is a dictatorship, with a regime that is not transparent and has a history of not reporting or under reporting disease outbreaks. New Scientist on January 8, 2019 reported on a 2016-2017 outbreak in which the outbreak went unreported or under reported.
"Cuba’s first case of Zika occurred in March 2016. A PAHO report says the country stopped providing updates on Zika in January 2017. In press reports in May 2017, Cuba said that nearly 1900 infections had been detected up to that point. But Nathan Grubaugh at the Yale School of Public Health and his colleagues estimate that the total cases in 2017 alone would have been more than double that at 5700. “Our results therefore suggest that the 2017 Zika outbreak in Cuba was similar in size to the known 2016 outbreaks in countries with similar population sizes,” the authors write."
Professor Duane Gubler of the Duke-NUS Medical School in Singapore, "says Cuba has a history of not reporting epidemics until they become obvious," reported New Scientist on January 8, 2019. Professor Gubler is an internationally recognized expert on Dengue fever, and the founding Director of the Program in Emerging Infectious Diseases which is affiliated with the Duke University-Graduate Medical School in Singapore. Dr. Gubler also served as a consultant/advisor on numerous World Health Organization committees.
In 1997 he pointed out the shortcomings of Havana's Dengue response: "The problem with the Cuban program," said Gubler, "and those that rely on a paramilitary-type of organizational structure is they have no sustainability. Once support and funds dry up, the program falls apart and the disease will come back with a vengeance," said the professor in the July 8, 1997 issue of Science. Consider what happens to doctors and journalists in Cuba who speak up in the midst of an outbreak, and do not tow the official line.
Calixto Martinez: Jailed for reporting on Cholera outbreak response by government.
News of a cholera outbreak in Manzanillo, in the east of the island, broke in El Nuevo Herald on June 29, 2012 thanks to the reporting of independent journalists in the island. The state controlled media did not confirm the outbreak until days later on July 3, 2012. The BBC reported on July 7, 2012 that a patient had been diagnosed with cholera in Havana. The Cuban government stated that it had it under control and on August 28, 2012 claiming the outbreak was over. Independent Cuban journalist Calixto Martinez, who broke the story, was arrested on September 16, 2012 by the Cuban Revolutionary Police "for investigating allegations that medicine provided by the World Health Organization to fight a cholera outbreak was being kept at the airport, as the Cuban government were allegedly trying to down-play the seriousness of the outbreak," according to Amnesty International that recognized him as a prisoner of conscience.
"On 6 March [2013], journalist Calixto Ramón Martínez Arias went on hunger strike to protest against his detention in Combinado del Este prison on the outskirts of Havana, Cuba. He was consequently transferred by the prison authorities to a punishment cell. According to his relatives,the small cell where he is now held has no light, toilet facilities or bedding, and he is not permitted to leave the cell to exercise in the open air. These kinds of punitive measures are typically used by the Cuban authorities against prisoners on hunger strike," reported Amnesty International on a March 14, 2013 update on his case.
Cholera patients in Cuba during the 2012-2013 outbreak
Although Cuban officials declared the Cholera outbreak over in August 2012, 11 months later and tourists visiting Cuba were returning home with the illness. In July 2013 an Italian tourist returned from Cuba with severe renal failure due to cholera. New York high school teacher Alfredo Gómez contracted cholera during a family visit to Havana during the summer of 2013 and was billed $4,700 from the government hospital. A total of 12 tourists were identified that had contracted cholera in Cuba. On August 22, 2013 Reuters reported that Cuba was still struggling with cholera outbreaks in various provinces.
This has been going on for years.
Dr Desi Mendoza Rivero, married with four children, was arrested on June 25, 1997. The Cuban doctor was jailed for warning about a dengue outbreak, and put on trial with the threat of a 13 year prison sentence. On November 28, 1997 he was sentenced to eight years in prison for "enemy propaganda." Amnesty International declared Dr. Mendoza Rivero a prisoner of conscience and campaigned for his freedom. He was released on November 20, 1998 "due to health reasons" following the visit of the Spanish Foreign Minister, under the condition that he leave Cuba for exile in Spain. First official report to the World Health Organization of the dengue outbreak was six months after the initial identification made by Dr Mendoza Rivero, and his reports were eventually confirmed.
But the press is not providing this background in its coverage of the current disease outbreak in Cuba, while giving the dictatorship the benefit of the doubt, although Politifact in 2014 observed that “the combination of the Cuban government’s heavy-handed enforcement of statistical targets and the lack of transparency has led some experts to suggest taking the numbers with a grain of salt.” Worse yet, instead of quoting a medical expert, NPR misidentified a pro-regime propagandist, who wrote Che Guevara: The Economics of Revolution, and held a conversation with a colleague linked to the Tricontinental, a continuation of an initiative that promoted international terrorism, as a neutral Cuba expert commenting on the Cuban healthcare system.
"this great humanity has said ... enough and started moving."
In addition there is not a comparison with the healthcare response of other Latin American countries to the current COVID-19 challenge to what has been done or not done in Cuba.
Whereas, Latin American countries engaged in campaigns to vaccinate their respective populations using vaccines that have been peer reviewed by scientific journals demonstrating their effectiveness, and others from Russia and China that are less vetted, Havana is waiting to develop its "own vaccines" and has yet to begin the wide scale vaccination of the Cuban population, but it has already started its propaganda offensive.
Propaganda offensive: Vaccine Tourism - Beach, Mojitos, Caribbean and Vaccines
Americas Society (AS) / Council of the Americas (COA) on March 29, 2021 reported on major developments in Latin America on vaccine roll outs as countries in the region strive to reach herd immunity. Below is a list of total doses administered per 100 people in Latin America, and Chile is leading with 50.38/100, the Dominican Republic is in sixth place with 7.37/100, followed by Costa Rica with 6.83/ 100. Cuba is not on the list, but in dead last is Venezuela with 0.04/100.
The attempt to judge the quality of healthcare in a dictatorship that lacks transparency is difficult, if not impossible and requires a skeptical approach. Professor Sherri L. Porcelain has taught Global Public Health in World Affairs at the University of Miami for more than 30 years. On September 21, 2017 the Cuban Studies Institute published her article: "U.S. & Cuba: A Question of Indifference?" and the observations she made remain relevant in 2021.
"Investment in the health of people includes protecting human rights. This means allowing the health community to speak out and not to be jailed for releasing information about a dengue epidemic considered a state secret, or not sharing timely data on a cholera outbreak until laboratory confirmation of travelers returning from Cuba arrive home with a surprising diagnosis. This causes me to reflect upon my personal interviews where the remaining vigor of public health actions in Cuba exists to fight vector and water borne diseases. Sadly, however, health professionals are directed to euphemistically use the vague terms of febrile illness in place of dengue and gastrointestinal upset for cholera, in contradiction to promoting public health transparency."
Why is it that the healthcare systems of Costa Rica, Chile and Canada's rate higher than the U.S. on international indices, but are not mentioned positively as often as Cuba's despite the island nation's health care system rating lower than the United States? Is it because those three countries do not need to set up propaganda and influence operations to justify their existing political systems, because they are democracies with popular support and the regime in Cuba is not?
Katherine Hirschfeld, is a medical anthropologist who spent time in Cuba examining the healthcare system and author of the book Health, Politics, and Revolution in Cuba Since 1898 published in 2009. In 2018 Professor Hirschfeld in the journal Health Policy and Planning made the case for democratic norms generating better results in public health in “Response to ‘Cuban infant mortality and longevity: health care or repression?’” and analyzed the shortcomings found in Havana’s governing style.
”The regime governs from the top down, as a dynastic military dictatorship that does not permit anyone outside the government—no independent associations of health professionals or journalists—to objectively assess policy outcomes. The role of public media in an autocracy is instead to praise the regime and explain away its failures as the work of real or imagined political enemies. Public information about health trends is correspondingly configured to fit these predetermined narratives.”
Americas Society (AS) / Council of the Americas (COA), Monday, March 29, 2021
Timeline: Tracking Latin America's Road to Vaccination
By Luisa Horwitz and Carin Zissis
The Chinese vaccine CoronaVac in Brazil. (AP)
AS/COA Online covers major developments and vaccine rollouts as countries strive to reach herd immunity.
Countries around the world are scrambling to get their citizens vaccinated, and it’s no surprise as to why Latin America would join the race: As of the end of 2020, Latin America and the Caribbean had over 15 million confirmed cases, and just over 500,000 deaths. To top it off, dose distribution is sparking a kind of vaccine Cold War, given that Beijing and Moscow are making large-scale vaccine pledges to several Latin American countries and putting pressure on Washington to share its supply as well.
Through charts and a timeline AS/COA Online maps out major regional vaccine developments, when countries kicked off vaccine campaigns, dose deliveries, vaccine approvals and accords, and clinical trials in an effort to cover Latin America’s progress toward vaccinations and, ultimately, herd immunity.
Chart: Progress of Vaccine Rollout
The World Health Organization has indicated that herd immunity against COVID-19 is achieved when 60 to 70 percent of a population is immune, although some medical experts have suggested the figure be higher. A year into the pandemic, just 3.3 percent of Latin Americans were confirmed to have had the disease, though reinfection—particularly with variants—is possible. The lion’s share of immunity will come from vaccinations.
A note for readers: Most vaccines being made available in the region require two doses, but some are of single dosage, such as Johnson & Johnson and CanSino.
[ Full Article ]
https://www.as-coa.org/articles/timeline-tracking-latin-americas-road-vaccination
New Scientist, January 8, 2019
Exclusive: Cuba failed to report thousands of Zika virus cases in 2017
Health 8 January 2019
Cuba fumigated to prevent the spread of Zika in 2016 Yamil Lage/AFP/Getty Images
THOUSANDS of Zika virus cases went unreported in Cuba in 2017, according to an analysis of data on travellers to the Caribbean island. Veiling them may have led to many other cases that year.
The analysis suggests that Zika infections peaked in Cuba in the second half of 2017, at a time when the virus was waning in mainland North and South America. Cuban authorities didn’t follow the agreed practice of notifying the Pan American Health Organization (PAHO) of the outbreak.
Cuba’s first case of Zika occurred in March 2016. A PAHO report says the country stopped providing updates on Zika in January 2017. In press reports in May 2017, Cuba said that nearly 1900 infections had been detected up to that point. But Nathan Grubaugh at the Yale School of Public Health and his colleagues estimate that the total cases in 2017 alone would have been more than double that at 5700.
“Our results therefore suggest that the 2017 Zika outbreak in Cuba was similar in size to the known 2016 outbreaks in countries with similar population sizes,” the authors write. They declined to comment on the work because it is under review for publication in a journal.
The team looked at the travel logs of 184 people who had contracted Zika while abroad and found that 95 per cent had been to Cuba. Such “hidden” outbreaks can spread epidemics to other countries because travellers and health authorities are unaware of the heightened risk of infection, the authors write (bioRxiv, doi.org/czdk).
The team also sequenced the genomes of Zika viruses retrieved from nine Floridians who travelled to Cuba. This showed that the infection was distinct from Zika infections that occurred in Florida. The travel cases revealed that the strains active in Cuba at the time were related to ones previously detected in other Latin American countries.
The team’s research suggests that the Cuban outbreak seems to have been caused by travellers from nearby countries bringing it in during 2016. It then persisted at low levels, before peaking late the following year.
This is an important discovery, says Duane Gubler at the Duke-NUS Medical School in Singapore. He says Cuba has a history of not reporting epidemics until they become obvious, and Zika is only mildly symptomatic in adults.
“One of the problems we have is that islands that depend on tourism are not forthcoming in immediate reporting,” he says.
Cuba’s Public Health Ministry hadn’t responded to requests for comment by the time this article went to press.
More visible consequences of the outbreak would be appearing now, says Peter Hotez at Baylor College of Medicine in Texas. “It should be possible to detect a blip or increase in birth defects starting around now,” he says. A fetus exposed to Zika during pregnancy risks being born with an abnormally small head, a condition known as microcephaly.
Elizabeth Brickley at the London School of Hygiene and Tropical Medicine says work like this could help fill in gaps in the global disease surveillance system. However, it will still be vital to confirm findings with research on the ground, she says.
Magazine issue 3212, published 12 January 2019
Cuban Studies Institute, September 21, 2017
U.S. & Cuba: A Question of Indifference?
By Sherri L. Porcelain
Professor Sherri L. Porcelain has taught Global Public Health in World Affairs at the University of Miami for more than 30 years.
Eli Weisel, Holocaust survivor, noble laureate and world-renowned author, passionately proclaimed, “We must always take sides. Neutrality helps the oppressor, never the victim.” I chose Weisel’s words to underscore the continuing philosophical and political debate on Cuba’s commitment to its people. I want to be clear; I do not intend to compare past or present acts in Cuba to the Holocaust. Nevertheless, Weisel’s words are persuasive and relevant.
I speak up, in part, as a promise, which I will explain later.
Since its inception, in 1948, the World Health Organization (WHO) has defined health as the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Accordingly, health extends beyond the physical to appropriately consider the mental and social welfare of people.
With this in mind, Cuba is promoted as having one of the world’s best approaches to public health. However, I ask this, “Can protecting public health be evaluated positively without embracing social justice and human rights?” Simply stated, these are core international values. The argument that evidence based research supports good health indicators in Cuba necessarily raises more questions. We know safe water, sewage, housing, waste disposal and good nutrition are all basic building blocks of a sound public health system and essential to positive health outcomes. Yet, Cuba’s failing systems have been widely observed and documented today with corroding and leaking water pipes, lack of garbage collection, spillage of sewage and dilapidated insufficient housing along with growing food insecurity.
During the 1980s, Cuba’s commitment to community-based health became the model for primary health care and was highly regarded by many practitioners, scientists, and leaders throughout the globe. Then I was intrigued by David Werner’s analysis questioning if Cuba’s health care system was a model of service or a form of social control [1]
In the mid-1990s a leader in the Cuban Ministry of Health presented at an international public health meeting in Washington, D.C., and he struck a chord with me. At that point, I asked the speaker and wider audience if they understood the depth of the anger and distrust of Fidel Castro’s regime by many Cuban Americans in Miami. Shortly after, Wayne Smith, former head of the US interests section in Cuba, offered a trip by charter flight to Cuban Americans in South Florida interested in an up close look at the public health situation in Cuba. I reached out to colleagues and others from the community with encouragement and a promise that as a Cuban American their participation would not be disclosed. Despite an Alpha 66 threat prior to departure and an empty promise of anonymity, I had to question both sides of the continuing debate.
The aggressive acts from the anti-Castro paramilitary group in Miami vs. the deception of the Cuban government opened a new window of idealism vs. realism for me. After apologizing to those who did not want their names or faces exposed, I questioned how robust was the health data measures presented when people didn’t have access to sufficient food, reliable potable water, soap, toilet paper, nor adequate garbage collection.
The zenith of Cuba’s “special period,” and the 1991-1993 epidemic of optic neuropathy from lack of sufficient vitamins, revealed a weakening society. How could this support the notion that public health was the government’s priority? More recently, I read with great interest Pedro Coutlin-Churchman’s journal article on Cuban Epidemic Neuropathy: A glimpse from inside a totalitarian disease[2] where he reminds us that even with a universal health care approach, the government controlled all food and markets, contributing to the suffering of its people.
Investment in the health of people includes protecting human rights. This means allowing the health community to speak out and not to be jailed for releasing information about a dengue epidemic considered a state secret, or not sharing timely data on a cholera outbreak until laboratory confirmation of travelers returning from Cuba arrive home with a surprising diagnosis. This causes me to reflect upon my personal interviews where the remaining vigor of public health actions in Cuba exists to fight vector and water borne diseases. Sadly, however, health professionals are directed to euphemistically use the vague terms of febrile illness in place of dengue and gastrointestinal upset for cholera, in contradiction to promoting public health transparency.
For years I have expressed a concern about the Cuban government’s refusal to share official public health data in a timely manner. This epidemiologic silence is most disturbing because Cuba has a robust health surveillance system. As recent as May 2017, Dr. Jason Harris, Associate Professor of Pediatrics at Harvard Medical School in an interview with Drug Development & Discovery Magazine remarked that while the Cuban government may not report cases, “there continue to be sporadic cases of cholera in travelers from Cuba,” further revealing a gap in global health diplomacy and security. This is occurring at the same time Cuba receives a top 2017 WHO recognition [3] for their support to international health emergencies, such as their response to Ebola, and other South – South collaborations.
Nevertheless, at home the Cuban government’s repression of rights continues. According to Human Rights Watch (2017) [4] from January to August 2016 there were 7,900 reports of arbitrary detention in Cuba, showing an increase in such detentions in recent years along with other repressive actions. State sovereignty allows for such internal actions, and yet no national or international state or non-state actors seems to be able to change the conversation.
It may take the graphic depiction of dragging, beating, and jailing members of the women’s human rights group Damas de Blanco, dissidents and independent journalists scrolling across a television, computer, or phone screen to reset the agenda, but soon after, unfortunately, the emotional reaction subsides and indifference sets in.
Is it that we remain silent in a noticeable attention deficient disorder world where one big event dominates the 24- hour news cycle until the next one arrives driving a fickle response? Has this become our twenty-first century style of indifference?
As Weisel so powerfully reminds us, the opposite of love is not hate; it’s indifference. The opposite of beauty isn’t ugliness; its indifference.” I suggest, indifference is a powerful word and exposes the perplexity of problems we face today. Yet, we can no longer be indifferent to the human rights violations 90 miles south, and then step up to revere a country for its promotion of primary health care. This is an inescapable compelling contradiction and we must all take notice.
As I stated earlier, I speak up, in part, because of a promise.
In March 2005, the MTV-University program that substitutes a celebrity for a professor, contacted me to bring Eli Weisel as a surprise guest lecturer to one of my classes. It’s been more than 12 years, and with Weisel’s passing on July 2, 2016 it is more important than ever that we speak up about injustices and refuse to remain indifferent. Weisel recounted the harrowing details of the Holocaust and the genocides in Rwanda and Sudan, and his appeal was for us all to address human rights violations, injustices of pain and suffering and to remain vigilant. Weisel encouraged students and faculty alike to not be spectators to an injustice and to speak out by writing letters to newspapers and leaders. This historical survivor then turned to me to request my promise to keep students engaged with these issues, and emphasized “an ethical person is one who is not indifferent.”
Clearly, Cuba is not the only country with documented continuing human rights violations; however, it seems Cuba is one known violator we are willing to overlook to promote the accolades of a free health care system, whether we question this or not.
I intend to keep the promise to embrace the words of Eli Weisel, may he rest in peace. I/we can no longer be indifferent.
Notes:
[1] David Werner (1979) authored Health Care in Cuba: A Model Service or a Means of Social Control- Or Both? Republished in Practicing Health for All, Morley, et. Al, New York, Oxford, 1983
[2] Pedro Coutlin-Churchman, The “Cuban Epidemic Neuropathy” of the 1990s: A glimpse from inside a totalitarian disease, Surg Neurol Int. 2014; 5:84
[3] World Health Organization, May 26, 2017, announces the Dr. Lee Jong-wook Memorial Prize for Public Health to the Henry Reeve International Medical Brigade (Cuba), http://www.who.int/mediacentre/events/2017/wha70/lee-jong-wook-prize/en/, accessed July 25, 2017
[4] Human Rights Watch Report 2017, https://www.hrw.org/world-report/2017/country-chapters/cuba, accessed July 25, 2017
https://cubanstudiesinstitute.us/international-relations/u-s-cuba-a-question-of-indifference/
Science, July 8, 1997
Dengue Fever Resurges in Cuba
Jul. 8, 1997 , 7:00 PM
An epidemic of dengue fever, a viral disease spread by mosquitoes, is now plaguing Cuba, according to local reports. Estimates of the number of cases range from 838, the last official government number, to as many as 30,000.
The epidemic is testimony to the perseverance of the mosquito that spreads dengue, Aedes aegypti, which virtually every country in the Western Hemisphere has tried to eliminate over the last 50 years, without success. After a devastating epidemic of dengue fever swept Cuba in 1981, claiming 158 lives, the government went after the mosquito with what public health experts describe as paramilitary zeal and soon claimed victory. But now the mosquito has signaled its return with the rising toll from dengue, a severe, flulike illness that can take a potentially fatal form known as dengue hemorrhagic fever. The number of deaths during the current epidemic has been reported variously from three to 20.
International experts say they know nothing more about the epidemic than what CubaPress, an independent news agency in Havana, has disseminated over the Web and the little the Cuban government has made officially available. But Duane Gubler, director of the Centers for Disease Control and Prevention's division of vector-borne diseases in Fort Collins, Colorado, says he and his colleagues had suspected for some time that a problem was building. As early as the winter of 1996, the Cuban government apparently contacted the international aid group Doctors Without Frontiers, asking for insecticide to kill larvae, plus backpack sprayers for killing adult mosquitoes indoors. By the spring of last year, travelers from Cuba were talking about dengue outbreaks, but until early this June there had been no official confirmation from the government.
Those familiar with dengue and Aedes aegypti aren't surprised by their resurgence. "The problem with the Cuban program," says Gubler, "and those that rely on a paramilitary-type of organizational structure is they have no sustainability. Once support and funds dry up, the program falls apart and the disease will come back with a vengeance." The only hope, he says, is a program in which individual communities take responsibility for clearing out the mosquito--but that has yet to succeed in Cuba or anywhere else.
https://www.sciencemag.org/news/1997/07/dengue-fever-resurges-cuba
Politifact, January 31, 2014
Sen. Tom Harkin says Cuba has lower child mortality, longer life expectancy than U.S.
By Louis Jacobson January 31, 2014
Sen. Tom Harkin, D-Iowa, recently spent three days in Cuba -- the longtime socialist adversary of the United States -- to learn more about the island nation’s health care system.
For years, some health policy specialists in the United States have been intrigued by Cuba’s health care system. Cuba produces a disproportionate number of doctors, and it has posted relatively strong health statistics in international comparisons, especially considering the country’s shortage of material goods and economic wealth.
For some liberals, Cuba’s health care system has offered an alternative to the one in the United States, where millions of Americans have struggled without insurance in recent years. Notably, Michael Moore’s 2007 health care documentary Sicko includes scenes where Americans in need of medical attention travel to Havana and are treated for free at a high-quality hospital. Critics have countered that such free, quality care is available only to the communist elite, not to ordinary Cubans.
Harkin certainly saw something promising in Cuba’s health care system. During a press conference upon his return to Washington on Jan. 29, 2014, Harkin -- who chairs the Senate Health, Education, Labor, and Pensions Committee -- said that Cuba is a "poor country, but they have a lower child mortality rate than ours. Their life expectancy is now greater than ours. It's interesting — their public health system is quite remarkable."
We wondered whether these statistics are accurate, and what they say about health care in Cuba.
Child mortality statistics
On child mortality, we found a few data sources that are generally considered credible. According to the CIA Factbook, Cuba infant mortality rate is indeed lower -- an estimated 4.76 deaths per 1,000 live births in 2013, compared to 5.90 for the United States.
And more precisely given the phrase Harkin chose, Cuba also has a better child mortality rate -- that is, the likelihood of death under 5 years of age. According to the World Health Organization, Cuba had 6 deaths under age 5 per 1,000 live births between 2005 and 2010, compared to 8 deaths for the United States.
So on child mortality, Harkin had his numbers right.
Life expectancy statistics
The data for life expectancy appears to be mixed. According to both the CIA Factbook, the estimated life expectancy for both sexes in 2013 was 78.62 in the United States, compared to 78.05 years in Cuba. And according to the World Health Organization, life expectancy in 2011 was 79 years in the United States and 78 in Cuba.
By these sources, Harkin would be wrong. But when we contacted Harkin’s office, they pointed us to data from Pan American Health Organization that backed up their claim. For 2012, the group found that life expectancy was 79.2 years in Cuba, compared to 78.8 years in the U.S.
So for life-expectancy numbers, the data is varied, with some supporting Harkin and some not.
How reliable is this data?
We wondered, however, whether the data from Cuba’s authoritarian government could be trusted. As we looked into it, we heard a measure of skepticism.
We did find one area of agreement: Cuba puts a lot of emphasis on its health data. Richard H Streiffer, dean of the College of Community Health Sciences at the University of Alabama, said his conclusion from two visits to Cuba is that Cuban health practitioners are "very compulsive about collecting data and reporting it regularly."
On a recent trip, Streiffer said, he spent time with a family doctor in a neighborhood clinic. "Family doctors are mandated to collect certain data," he said. "He had right on his wall a ‘dashboard’ of data characterizing his practice -- an age/sex distribution; an age/sex distribution of the top 10 chronic diseases in his practice; a map of where his patients lived in the neighborhood. You don't find that in the US."
However, some experts said that this obsession with statistics can be a two-edged sword when it comes to reliability. Some say Cuba is so concerned with its infant mortality and life-expectancy statistics that the government takes heavy-handed actions to protect their international rankings.
"Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain these favorable statistics," said Tassie Katherine Hirschfeld, the chair of the department of anthropology at the University of Oklahoma who spent nine months living in Cuba to study the nation's health system. "They are pressured to undergo abortions that they may not want if prenatal screening detects fetal abnormalities. If pregnant women develop complications, they are placed in ‘Casas de Maternidad’ for monitoring, even if they would prefer to be at home. Individual doctors are pressured by their superiors to reach certain statistical targets. If there is a spike in infant mortality in a certain district, doctors may be fired. There is pressure to falsify statistics."
Hirschfeld said she’s "a little skeptical" about the longevity data too, since Cuba has so many risk factors that cause early death in other countries, from unfiltered cigarettes to contaminated water to a meat-heavy diet. In a more benign statistical quirk, Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, suggests that the flow of refugees could skew longevity statistics, since those births are recorded but the deaths are not.
Transparency would help give the data more credibility, but the Cuban government doesn’t offer much, experts said.
"I would take all Cuban health statistics with a grain of salt," Hirschfeld said. Organizations like the Pan-American Health Organization "rely on national self-reports for data, and Cuba does not allow independent verification of its health claims."
Rodolfo J. Stusser -- a physician and former adviser to the Cuban Ministry of Public Health's Informatics and Tele-Health Division who left for Miami at age 64 -- is another skeptic. While Stusser acknowledges that Cuba has improved some of its health numbers since the revolution, the post-revolution data has been "overestimated," he said. "The showcasing of infant mortality and life expectancy at birth has been done for ideological reasons," he said.
Our ruling
Harkin said that Cuba has "a lower child mortality rate than ours. Their life expectancy is now greater than ours."
According to the official statistics, Cuba does beat out the United States for both infant and child mortality, and on life expectancy, the data is mixed, with a slight edge to the United States. However, the combination of the Cuban government’s heavy-handed enforcement of statistical targets and the lack of transparency has led some experts to suggest taking the numbers with a grain of salt. On balance, we rate Harkin’s claim Half True.
Our Sources
National Journal, "Sen. Tom Harkin Visits Cuba, Is Pretty Impressed With Its Public Health System," Jan. 29, 2014
CIA World Factbook, Infant mortality rate, 2013
World Health Organization, under-5 mortality table, 2012
World Health Organization, life expectancy at birth table, 2012
CIA World Factbook, life expectancy at birth table, 2013
World Health Organization, life expectancy at birth table, 2011
Pan-American Health Organization, "Health Situation in the Americas: Basic Indicators," 2012
Rodolfo J. Stusser, "Demystifying the Cuban Health System: An Insider's View," 2011
C. William Keck and Gail A. Reed, "The Curious Case of Cuba," American Journal of Public Health, June 14, 2012
New York Times, "‘Sicko,’ Castro and the ‘120 Years Club,'" May 27, 2007
Miami Herald, "Cuban healthcare is painted rosy in 'Sicko,' critics say," June 23, 2007
Email interview with Richard H Streiffer, dean of the College of Community Health Sciences at the University of Alabama, Jan. 30, 2013
Email interview with Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, Jan. 30, 2014
Email interview with Rodolfo J. Stusser, physician and former adviser to the Cuban Ministry of Public Health's Informatics and Tele-Health Division, Jan. 30, 2014
Email interview with Tassie Katherine Hirschfeld, chair of the department of anthropology at the University of Oklahoma and author of Health, Politics and Revolution in Cuba since 1898, Jan. 30, 2014
Read About Our Process
The Principles of the Truth-O-Meter
Amnesty International, January 30, 2013
Cuban journalist named prisoner of conscience
30 January 2013, 00:00 UTC
Authorities in Cuba must immediately release Cuban journalist Calixto Martínez, currently imprisoned for reporting on issues seen by the authorities as “controversial”, said Amnesty International today as it named him a prisoner of conscience.
Calixto Martínez, journalist with the unofficial news agency Hablemos Press, was arrested by the Cuban Revolutionary Police on 16 September 2012 near Havana airport.
He was investigating allegations that medicine provided by the World Health Organization to fight a cholera outbreak was being kept at the airport, as the Cuban government were allegedly trying to down-play the seriousness of the outbreak.
While at the airport he telephoned his colleagues at Hablemos Press to inform them that he had taken photographs and had interviewed airport workers. He was arrested shortly after.
When he asked the reason for his arrest the police told him they were just following an order.
Even though he was not formally charged or faced court, the police are reportedly accusing him with “disrespect” towards President Raúl Castro and his brother Fidel.
The Cuban state maintains a total monopoly on all media in the country, including television, radio, the press, internet service providers, and other electronic means of communication.
“The imprisonment of Calixto Martínez goes to show that authorities in Cuba are far from accepting that journalists have a role to play in society, including by investigating possible wrongdoings,” said Guadalupe Marengo, Deputy Director of the Americas programme at Amnesty International.
Prior to his September arrest, Martínez had been detained without charge on several occasions in 2012, always in relation to his work as a journalist.
There are currently 2 prisoners of conscience in Cuba.
https://www.amnesty.org/en/press-releases/2013/01/cuban-journalist-named-prisoner-conscience/
Amnesty International, November 20, 1997
News Service 199/97
AI INDEX: AMR 25/41/97
20 NOVEMBER 1997
Cuba: Doctor facing 13-year sentence for “enemy propaganda” should be immediately released
Amnesty International is today calling for the immediate and unconditional release of Cuban doctor and prisoner of conscience, Desi Mendoza Rivero, who is facing a possible 13-year sentence next Monday for using the mass media to spread “enemy propaganda”.
“Desi Mendoza Rivero was detained simply for accusing the Cuban authorities of covering up the true extent of a dengue fever epidemic and of not taking sufficient measures to control it,” Amnesty International said today. “Expressing views which are at odds with official positions is no reason to be taken to court.”
Forty-three-year-old Dr Mendoza, who has been in detention since his arrest on 25 June 1997 and is currently held in Boniato Prison, just outside Santiago de Cuba, was tried in that city on 18 November.
Sentencing is expected on 24 November. The basis of the charge against him was that he had issued statements, which were later disseminated by foreign newspapers and broadcast media, regarding an epidemic of dengue fever in Santiago de Cuba which, according to him, had caused several deaths.
According to reports of the six-hour trial, the prosecution requested a 13-year sentence for Dr Mendoza, who was able to speak on his own behalf for some 40 minutes. His lawyer refuted each of the allegations against him and refrained from requesting a lower sentence on the grounds that in his view Dr Mendoza had committed no crime. When several members of the public applauded the lawyer’s statement, they were removed from the courtroom.
All media in Cuba are state-controlled and dissidents are frequently arrested and imprisoned for speaking out against the government and criticizing its policies.
In 1994, Dr Mendoza founded the Colegio Médico Independiente de Santiago de Cuba, Santiago de Cuba Independent Medical Association, an unofficial organization not recognized by the Cuban authorities of which he is president, and it is believed that the action against him may be at least partly in reprisal for his peaceful activities with that organization. ENDS…/
https://www.amnesty.org/download/Documents/156000/amr250411997en.pdf