Cuba's Universal Healthcare System : A Visiting Scholar's View

1. Cuba's Universal Healthcare System:A Visiting Scholar's View Carol A. Gosselink, Ph.D. Gerontology Program Department of Psychology CHHS Presentation, February 18, 2011

2. Cuba Visit: How & When • National Council on Aging (N=2700) delegate • U.S. Treasury & State Departments validate scholarship • Taca Airlines, Miami • In country December 4-9, 2010 • $—Mom

3. Destination: Havana, Cuba

4. Cuba Facts* • 93 miles south of Key West, FL • Slightly smaller than Pennsylvania • 11,477,459 inhabitants • Life expectancy: 77.64 years (2010 estimate) • male: 75.36 years • female: 80.05 years • $9,900 per capita income (2010 estimate) • By 2025, 25% of population will be >60 years old** *Source for all but last bullet: CIA **Dr. Menendez at CITED in Cuba

5. Cuba-U.S. Relations • 1959: Fidel Castro topples Batista • 1962: U.S. embargo of Cuba • 1996: U.S. Helms–Burton Act • Cubans call it “blockade” • 889/1,297 Rx (WHO, 1997) • Restricts new medical equipment • Limited internet

6. Constitution of Cuba Article 50: Everyone has the right to health protection and care.

7. Healthcare System Principles • Universal • Free of charge • Accessible • Regionalized • Comprehensive

10. National Health System Institutions • 499 polyclinics • 160 dental clinics • 219 hospitals • 335 maternal homes • 299 homes for elders • 35 homes for people with disabilities • 25 blood banks • 14 research institutes

11. Healthcare Human Resources • 532,538 workers • 70.1 % women • In Cuba, per 10,000 inhabitants, there are • 94.7 nurses • 66.6 physicians • 10.3 dentist

12. Cuban Infant Mortality

14. Pregnancy & Prenatal Care • Fertility rate: 1.7 births per female • Planned pregnancy • Free counseling • Accessible no-cost contraceptives • Abortion (“failure of the system”) • 12 prenatal care visits

15. Maternal Homes • Problem pregnancies referred by family MD • Some short duration • Others stay • At-risk mothers live there; transfer to hospital for delivery • Later-term pregnant women in mountains move to maternal homes to be near hospital • Pregnant women/family unable to follow prenatal care directions

16. Maternal Homes • Attended by team • medical doctor • nurse • social worker • obstetrician-gynecologist • psychologist • If mother/fetus not thriving, dietary referral

17. Smoking • 19.2% young Cubans smoke • Raised prices. Still smoke • 1/3 older Cubans smoke • Elders formerly got tobacco “quota” • Acknowledged hard to stop lifetime habit • Sold to youth • 2005: strict smoking ban

18. Smoking Cessation • Smokers referred to cessation program • Multidisciplinary team • MD • nurse • psychologist • alternative medicine practitioner • floral therapy • Identify issues/stressors • Seventh session, out if hasn’t quit

19. Diabetes • Rising as in U.S., but difficult to compare • Cuba uses different Hemoglobin A1c (HbA1c) than U.S. (6.7 vs. 6.5) • All Cubans get annual exam—check diabetes status • If diabetic • Recheck every 3 months • Referral to diabetes institute

20. Diabetes Centers • All polyclinics have diabetes centers • Multidisciplinary team (MD, RN, SW, psychologist) • Teach • health promotion • how to avoid complications • Intensive treatment • deal immediately with foot ulcers • avoid amputation

21. Obesity • Severe economics=malnutrition • Traditional Cuban diet • Spanish heritage • Pork, chicken, plantains, root vegetables, beans & rice • High sugar intake (20% of daily calories) • Intensive nutrition campaign • Fruits and vegetables • Limited agriculture

22. Drugs & Alcohol • Very few drug addicts • Severe legal penalties • Cubans don’t have $ • Alcoholism • Cuban rum • Mojitos!

23. Public Health—Mosquitos

24. System Keeps Elders Home • Family doctor close by • House calls T & R • In-home caregivers • Extensive PT/OT/mental health therapy • Live with adult child/grandchildren • Day centers called Grandparents Houses

25. Grandparents Houses

26. Some Facts • Grandparent house runs with 5 workers • 650 older adults in day program • 4 permanent residents • Assess elders’ wellbeing (clothes/dishevelment) • Wash clothes • PT, OT, heat therapy • Room to treat 24 w/ physical & electromagnetic therapy • Local family MD integrated in care plan

27. Convento de Belen: Repurposed

28. Morning Exercise

29. Socializing

30. Theatre

31. Music Therapy

32. Art Therapy

33. Welcoming

34. Nutrition (and economics) • Director plans food/snacks • Elders get two snacks a day • Yogurt or Milk • Cheese sandwich • 30 elders get all their meals on site • Director wants to feed more but budget tight • Buys yogurt in market with CUCs so costly

35. OT/PT

36. Alternative therapies

37. Rehabilitation

38. Aviary

39. A few beds for longer stays

40. Longer Stays • After treatment program of 2-3 weeks, elders’ health so improved can go home • Rooms for patients who sleep at center • Doctor volunteers • Nurse full time • Don’t wear “whites” • Not home but not hospital

41. Healthcare System Overall?My Conclusion • Longevity, infant mortality, multi-disciplinary team approach, little institutionalization of elders show results! • System works on shoestring budget • Old equipment, “ugly” facilities

44. Healthcare System Overall?My Conclusion • Caring practitioners—Latin culture helps • Part of master plan from “ministries” • U.S. embargo bad for healthcare • Would Cuban plan work in U.S.?

45. Questions?