[Marxism] Why Infants May Be More Likely to Die in America Than Cuba

Louis Proyect lnp3 at panix.com
Sun Jan 20 11:02:34 MST 2019


(Despite its cavils, an important piece.)

NY Times Op-Ed, Jan. 20, 2019
Why Infants May Be More Likely to Die in America Than Cuba
By Nicholas Kristof

HAVANA — Claudia Fernández, 29, is an accountant whose stomach bulges 
with her first child, a girl, who is due in April.

Fernández lives in a cramped apartment on a potholed street and can’t 
afford a car. She also gets by without a meaningful vote or the right to 
speak freely about politics. Yet the paradox of Cuba is this: Her baby 
appears more likely to survive than if she were born in the United States.

Cuba is poor and repressive with a dysfunctional economy, but in health 
care it does an impressive job that the United States could learn from. 
According to official statistics (about which, as we’ll see, there is 
some debate), the infant mortality rate in Cuba is only 4.0 deaths per 
1,000 live births. In the United States, it’s 5.9.

In other words, an American infant is, by official statistics, almost 50 
percent more likely to die than a Cuban infant. By my calculations, that 
means that 7,500 American kids die each year because we don’t have as 
good an infant mortality rate as Cuba reports.

How is this possible? Well, remember that it may not be. The figures 
should be taken with a dose of skepticism. Still, there’s no doubt that 
a major strength of the Cuban system is that it assures universal 
access. Cuba has the Medicare for All that many Americans dream about.

“Cuba’s example is important since for decades ‘health care for all’ has 
been more than a slogan there,” said Dr. Paul Farmer, the legendary 
globe-trotting founder of Partners in Health. “Cuban families aren’t 
ruined financially by catastrophic illness or injury, as happens so 
often elsewhere in the neighborhood.”

In Havana, I shadowed a grass-roots doctor, Lisett Rodríguez, as she 
paid a house call on Fernández — and it was the 20th time Dr. Rodríguez 
had dropped in on Fernández’s apartment to examine her over the six 
months of her pregnancy. That’s on top of 14 visits that Fernández made 
to the doctor’s office, in addition to pregnancy consultations Fernández 
held with a dentist, a psychologist and a nutritionist.

This was all free, like the rest of the medical and dental system. It’s 
also notable that Cuba achieves excellent health outcomes even though 
the American trade and financial embargo badly damages the economy and 
restricts access to medical equipment.

Fernández has received more attention than normal because she has 
hypothyroidism, making her pregnancy higher risk than average. Over the 
course of a more typical Cuban pregnancy, a woman might make 10 office 
visits and receive eight home visits.

Thirty-four visits, or even 18, may be overkill, but this certainly is 
preferable to the care common in, say, Texas, where one-third of 
pregnant women don’t get a single prenatal checkup in the first trimester.

Missing a prenatal checkup is much less likely in Cuba because of a 
system of front-line clinics called consultorios. These clinics, staffed 
by a single doctor and nurse, are often run down and poorly equipped, 
but they make health care readily available: Doctors live upstairs and 
are on hand after hours in emergencies.

They are also part of the neighborhood. Dr. Rodríguez and her nurse know 
the 907 people they are responsible for from their consultorio: As I 
walked with Dr. Rodríguez on the street, neighbors stopped her and asked 
her about their complaints. This proximity and convenience, and not just 
the lack of fees, make Cuba’s medical system accessible.

“It helps that the doctor is close, because transportation would be a 
problem,” Fernández told me.

Home visits are also a chance to reach elderly and disabled people and 
to coach dysfunctional families, such as those wracked by alcoholism (a 
common problem), and to work on prevention. During Dr. Rodríguez’s 
visits to Fernández, for example, they discuss breast-feeding and how to 
make the home safe for the baby.

“It’s no secret that most health problems can be resolved at the 
primary-care level by the doctor, nurse or health worker nearest you,” 
said Gail Reed, the American executive editor of the health journal 
Medicc Review, which focuses on Cuban health care. “So, there is 
something to be said for Cuba’s building of a national primary-care 
network that posts health professionals in neighborhoods nationwide.”

Each consultorio doctor is supposed to see every person in the area at 
least once a year, if not for a formal physical then at least to take 
blood pressure.

All this is possible because Cuba overflows with doctors — it has three 
times as many per capita as the United States — and pays them very 
little. A new doctor earns $45 a month, and a very experienced one $80.

The opening of Cuba to tourism has created some tensions. A taxi driver 
who gets tips from foreigners may earn several times as much as a 
distinguished surgeon. Unless, of course, that surgeon also moonlights 
as a taxi driver.

Critics inside and outside the country raise various objections to the 
Cuban system. Corruption and shortages of supplies and medicine are 
significant problems, and the health system could do more to address 
smoking and alcoholism.

There are also allegations that Cuba fiddles with its numbers. The 
country has an unusually high rate of late fetal deaths, and skeptics 
contend that when a baby is born in distress and dies after a few hours, 
this is sometimes categorized as a stillbirth to avoid recording an 
infant death.

Dr. Roberto Álvarez, a Cuban pediatrician, insisted to me that this does 
not happen and countered with explanations for why the fetal death rate 
is high. I’m not in a position to judge who’s right, but any 
manipulation seems unlikely to make a huge difference to the reported 
figures.

Outsiders mostly say they admire the Cuban health system. The World 
Health Organization has praised it, and Ban Ki-moon, the former United 
Nations secretary general, described it as “a model for many countries.”

In many ways, the Cuban and United States health care systems are mirror 
opposites. Cuban health care is dilapidated, low-tech and free, and it 
is very good at ensuring that no one slips through the cracks. American 
medicine is high-tech and expensive, achieving some extraordinary 
results while stumbling at the basics: A lower percentage of children 
are vaccinated in the United States than in Cuba.

The difference can also be seen in treatment of cancer. Cuba regularly 
screens all women for breast and cervical cancer, so it is excellent at 
finding cancers — but then it lacks enough machines for radiation 
treatment. In the United States, on the other hand, many women don’t get 
regular screenings so cancers may be discovered late — but then there 
are advanced treatment options.

As Cuba’s population becomes older and heavier (as in the United States, 
the nutrition problem here is people who are overweight, not 
underweight), heart disease and cancer are becoming more of a burden. 
And the lack of resources is a major constraint in treating those ailments.

Cuba invests heavily in health care partly because it’s a moneymaker. 
Cuba exports doctors to other countries, and this has become an 
important source of hard currency (the doctors earn a premium while 
abroad, but much of the surplus goes to the government).

With its doctors, Cuba creates a global public good: I’ve encountered 
Cuban physicians in impoverished countries around the world, and Cuba 
also trains many doctors from Haiti and other countries. Hundreds of 
Cuban physicians also risked their lives to travel to West Africa during 
the Ebola crisis.

Cuba has developed its own pharmaceutical industry, partly to get around 
the American embargo, and this also creates financial opportunities. A 
lung cancer medication from Cuba is now undergoing a clinical trial in 
the United States, and a similar U.S.-Cuba partnership is pursuing a 
Cuban treatment for diabetic foot ulcers. To me, those partnerships 
represent a path toward cooperation that both sides should build on.

While we should call on Cuba to grant people like Fernández meaningful 
political rights, we should likewise push for American babies born in 
low-income families to have the same opportunity for attentive health 
care as her daughter will have.

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