The US attack on Cuba's health
CMAJ 1997;157:1511
Re: "The US attack on Cuba's health" (CMAJ 1997;157[3]:281-4 [full text / résumé]), by Dr. Anthony F. Kirkpatrick
See response from: A.F. Kirkpatrick
Dr. Kirkpatrick's article addressed a 6-page "fact sheet" from the US State Department, which was published in May 1997 and discussed health care in Cuba.1 The fact sheet was republished in revised form in August.2 Unfortunately, the new sheet is also replete with misinformation.
It states that the US has licensed $227 million in humanitarian donations of medicines and medical equipment since 1992, but it fails to mention that the actual value of goods shipped is much less. It is estimated that about half of all licensed goods are actually sent and that the value of donated goods is heavily inflated for tax purposes. The Cuban Ministry of Health estimates that about $10 million in donated goods is received from the US each year. If this is so, the real value of donated goods is less than a quarter of the amount given by the State Department.
The fact sheet states that shipping adds 2% to 3% to the cost of imported medical goods. The Cuban Ministry of Health estimates excess costs to the health system due to the US embargo at a more realistic 30%.3 The fact sheet states that Cuba imported $46 million in medical goods in 1995; the Ministry of Health recorded $120 million in medical imports.
Contrary to State Department assertions, Cuba has committed a remarkably high proportion of funds to its health care system, which consumed 6.6% of the budget in 1990 and 9.6% in 1996.4 This helps to explain why infant and maternal mortality levels, already low before the dissolution of the Soviet Union, continue to decline and are now at their lowest levels in history.
The fact sheet criticizes Cuba for generating foreign exchange through the sale of medical products and services because this is done "at the expense of providing health-care to ordinary Cubans." In 1996, the Cuban health system generated 20% of all operating expenses from just the type of entrepreneurial activities the US has encouraged in other poor countries.
Richard Garfield, RN, DrPH
Columbia University School of Nursing
New York, NY
References
- Office of the Spokesperson, US Department of State. The US embargo and healthcare in Cuba: myths versus reality [fact sheet]. Washington: Department of State; 14 May 1997.
- Office of the Spokesperson, US Department of State. The US embargo and healthcare in Cuba: myths versus reality [fact sheet]. Washington: Department of State; 5 Aug 1997.
- Garfield R, Santana S. The impact of economic crisis and the US embargo on health in Cuba. Am J Public Health 1997;87:15-20.
- Financiamiento de la salud. Havana, Cuba: Division of Planning, MINSAP; 1997.
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