Bloomberg Healthiest Country Index results of 2019 edition have been announced, day before yesterday. The index grades nations based on variables including life expectancy while imposing penalties on risks such as tobacco use and obesity. It also takes into consideration environmental factors including access to clean water and sanitation. The index puts Spain as the healthiest nation, and the US at 35th position. Cuba is placed five spots higher than US at 30th position, making it the only nation not classified as 'high income', to be ranked that high on the index.
One reason for Cuba's health is attributed to an emphasis on preventive care. The focus in more developed economies like US is on diagnosing and treating illness, rather than preventing illness. Prioritizing primary health care, which is provided by public providers, specialized family doctors and staff nurses, by getting preventive services to children, women and elderly patients.There is a concept of socialized health care, adopted by Cuba, and some other countries in the world. 'Socialized Healthcare' is the universal health care system, provided free, largely by the government, on a no-profit basis, prioritizing primary care and prevention as well as addressing social determinants of health. It is about making 'health' available to all, irrespective of social or economic status. It is about developing a health system, which serves all, which brings equality, through healthcare.
Cuba spent 10.57% on health, as per 2014 statistic, which is higher than many countries in the world. Cuba’s “army of white coats”, as it was termed by Fidel Castro,was formed in 1960. Today, around 50,000 Cuban medical workers are present in 67 countries. The healthcare industry is also one of the country’s main sources of income.Doctors are arguably Cuba’s most profitable resource and the country’s medical missions have proved to be a lucrative diplomatic tool. In 2014, Cuban authorities estimated overseas healthcare services would bring in $8.2 billion, putting it ahead of tourism.
Cuban medical schools, which are government-run and tuition-free, incorporate primary care, public health, and social determinants in their curricula. Cuban medical education system, comprises of a student entering into a six-year training directly from high school, and first educated as primary care practitioner. Later, those who wish to specialize go for a post-graduate degree.
The set-up and structure of Cuba's health is a geographic-based health care system. The Cuban 'consultorio' comprises a doctor and nurse team who provides basic primary care services for 600–900 patients in both the clinic and patients' homes. Mornings are devoted to OPD, and afternoons for a household visit to address prevention needs, and counselling about environmental factors affecting health. Physicians are expected to understand a patient's family and social backgrounds and reach out to those who typically avoid interaction. Cuban health care system stresses the physicians' role to promote public health and their moral obligation to address health care disparities and inequalities. For more complex services, physicians refer patients to local polyclinics, each serving a single geographic area of approximately 25,000–35,000 people.
Why is it essential for a doctor to understand social determinants of health such as education, housing, environmental elements (e.g. sanitation and clean air), food and nutrition, and employment? The simple answer is that many diseases can be prevented when these aspects are addressed. Lack of education, adequate nutrition, unclean environment, lack of clean drinking water, housing conditions, poverty, unemployment, and the resultant stress in life is the cause of diseases. Treatment does not address the cause, social, behavioral and public health interventions do.
Considerable amount of data that is collected on a regular basis, through household visits is used to drive innovations for unique and local health problems. Data also helps in getting to the crux of the problems. Health interventions incorporating social and behavioral change are planned based on data.
Cuban health system is still far from perfect. There are chronic medicine shortages. Facilities often lack basic supplies or equipment, and physicians receive poor compensation. There are clinics which cater to medical tourists and VIPs and they have better facilities.Yet each dollar spent on healthcare brings about better results than some of the developed countries, including US.
The key is in realizing that ensuring health to all the citizens as a basic human right, and making efforts to bring 'health' out of the demand supply based pricing system. Preventive care methods establish health as a condition, and not as a service. Being healthy is a right of a human being and socio-political structures must respond to that.
If India wants to develop a healthcare system like that of Cuba, structural changes, in infrastructure and law would be required. One can argue that a strong political will and public opinion will be required. As a matter of fact, there is no way out. India doesn't have resources to follow the curative care path like US. Preventive care is much less costlier than curative care and thus it brings more value per dollar spent.
We consume tobacco, have developed junk food eating habits, pollute air and water, do less exercise, and create stressful lifestyles. Inequality creates more stressful societies - be it economic or social.
Can't we have the national consciousness to utilize health to bring in a more equal society? Can't we have the political and social will to bring in structural changes?
