Easing of US Trade Embargo, the Cuban Paradox, and Lessons in Health Care: A Natural Experiment

Christopher J. Fries, University of Manitoba, Canada

Since 1960 Cuba has been a under trade embargo by the United States. The results of this embargo, imposed by one of the world’s wealthiest, industrialized nations on a country with a population of less than 12 million, have been grave for the nation’s economy and the formal health care system of Cuba, especially since the collapse of the Soviet Union. The loosening of trade restrictions announced by US President Obama in 2014 and now working their way through American Congress constitute an interesting natural experiment on the relationship between economic development and population health. It will be fascinating to watch how freer trade affects measures of population health status, such as life expectancy and infant mortality, in Cuba. However, the case of Cuba already holds lessons about the relationship of the health care system to population health.

During the Cold War period (1946 – 1989), the Soviet Block provided financial support and trade to Cuba that helped shield the island nation from the economic effects of the embargo. The embargo prohibits US companies and their subsidiaries from trading with Cuba. As part of the embargo, medicine and health care supplies cannot be traded to Cuba. After the collapse of the Soviet Union and with it, foreign aid, first the economy and then the health of Cuba suffered. For instance, Stanford University, School of Medicine, researchers Paul Drain and Michele Barry show that owing to food shortages, average adult caloric intake decreased 40 per cent, the percentage of underweight newborns increased 23 per cent, the number of surgeries performed declined by 30 per cent, the number of pharmaceutical medicines available declined from 1300 to less than 900, and Cuba’s total mortality rate increased 13 per cent.

However, and surprisingly, despite the embargo, Cuba has the highest average life expectancy and the lowest infant and child mortality rates among 33 Latin American and Caribbean countries. In fact, on several key measures of the health of a population, Cuba is doing about as well as, or even slightly better in comparison with the far richer countries of Canada and the United States! For instance, according to the latest data from the World Health Organization, at 78 years, average Cuban life expectancy is only four less than Canada’s 82 years and about the same as the US’s 79 years. The WHO reports that Cuba’s infant mortality rate (5/1000 live births) approximates Canada’s (4.6/1000 live births) and betters the US rate of 5.9/1000 live births.

Cuba is a poor country that spends about $405 per capita total spending on health care. This compares with the $4,610 spent in Canada and $8,845spent by the US. In other words, Canada spends more than ten times what Cuba does on health care and the US spends more than twenty times as much! Despite this and the challenges to the Cuban health care system stemming from the embargo, on many measures Cubans are as healthy as Canadians and Americans.

Though countries like the US and Canada spend much more on our formal health care systems than does Cuba, we do not receive matching returns in terms of population health. This is sometimes referred to in the health research literature as ‘the Cuban health paradox’. Cuba is achieving world-class population health outcomes on its developing-world budget. How is this possible? The Cuban experience clearly illustrates that there is more to health care than expensive, high-tech medical products and services. It is possible to spend less and get more! This is because, as the Cuban Paradox demonstrates, medicine does not equate with health.

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