Cuban Medical Diplomacy: When the Left Has Got It Right The Cuban Threat: Medical Diplomacy
Living in a hostile neighborhood led Fidel to look for allies elsewhere. Part of this process has included the conduct of medical diplomacy, which is the collaboration between countries to improve relations and simultaneously produce health benefits. Medical diplomacy has been a cornerstone of Cuban foreign policy and its foreign aid strategy since shortly after the triumph of the 1959 revolution. Despite Cuba?s own economic difficulties and the exodus of half of its doctors, Cuba began conducting medical diplomacy in 1960 by sending a medical team to Chile to provide disaster relief aid after an earthquake. Three years later, and with the US embargo in place, Cuba began its first long-term medical diplomacy initiative by sending a group of fifty-six doctors and other health workers to provide aid in Algeria on a fourteen-month assignment. Since then, Cuba has provided medical assistance to scores of developing countries throughout the world both on a long-term basis and for short-term emergencies.
And now, with help from his friend, Hugo Chávez, who is awash in oil wealth, Fidel is threatening to provide massive amounts of medical aid to improve the health of poor Latin Americans. Rather than a fifth column promoting socialist ideology, these doctors provide a serious threat to the status quo by their example of serving the poor in areas in which no local doctor wouldwork, by making house calls a routine part of their medical practice and by being available free of charge 24/7, thus changing the nature of doctor-patient relations. As a result, they have forced the re-examination of societal values and the structure and functioning of the health systems and the medical profession within the countries to which they were sent and where they continue to practice. This is the current Cuban threat.
Over the past forty-five years, Cuba?s conduct of medical diplomacy has improved the health of the less privileged in developing countries while improving relations with their governments. By the close of 2005, Cuban medical personnel were collaborating in 68 countries across the globe. Consequently, Cuban medical aid has affected the lives of millions of people in developing countries each year. And to make this effort more sustainable, over the years, thousands of developing country medical personnel have received free education and training either in Cuba or by Cuban specialists engaged in on-the-job training courses and/or medical schools in their own countries. Today, over 10,000 developing country scholarship students are studying in Cuban medical schools. Furthermore, Cuba has not missed a single opportunity to offer and supply disaster relief assistance irrespective of whether or not Cuba had good relations with that government. This includes an offer to send over 1000 doctors as well as medical supplies to the United States in the immediate aftermath of Hurricane Katrina. Although the Bush administration chose not to accept the offer, the symbolism of this offer of help by a small, developing country that has suffered forty-five years of US hostilities, including an economic embargo, is quite important.
Because good health is necessary for personal well-being as well as societal development, the positive impact of Cuba?s medical aid to other countries has greatly improved both its bilateral relations with those countries as well as its standing and support in a number of multilateral forums. Therefore, as a consequence of its medical diplomacy Cuba has accumulated considerable symbolic capital (goodwill, prestige, influence, credit and power). The creation of symbolic capital requires an initial investment of material capital as well as time in a given project, such as the efforts mentioned above. The resulting symbolic capital may be accumulated, invested and spent just like material capital. Eventually, it can be converted into material capital, which in Cuba?s case has meant both bilateral and multilateral aid as well as trade, credit and investment. This is one of the rewards for the conduct of medical diplomacy.
From the outset of the revolution, Fidel has made the health of the individual a metaphor for the health of the body politic. Therefore, he made the achievement of developed country health indicators a national priority. Rather than compare Cuban health indicators with those of other countries at a similar level of development, he began to compare them to those of the United States. This was particularly true for the infant mortality and life expectancy rates. Both are considered to be proxy indicators for socioeconomic development because they include a number of other indicators as inputs. Among the most important are sanitation, nutrition, medical services, education, housing, employment, equitable distribution of resources, and economic growth. It is, therefore, symbolically important for Cuba to compare favorably with the US in an effort to demonstrate what Fidel sees as the moral superiority of Cuba?s social development policies.
This striving for first world health has been so important that in many of his major speeches, Fidel has dedicated considerable time to discussing his island?s health indicators. His annual July 26 speech this year, given right before his own serious illness was made known to the public, was no exception. In it, Fidel cited the latest data: Cuba?s infant mortality rate was 5.6 per 1000 live births, a figure less than that of the United States, which was 7.0 per 1000 live births according to the latest published data (NCHS 2005, data are for 2002). Life expectancy at birth in Cuba today is the same as for US citizens, 77 years. These achievements make Cuba a model and therefore make possible its medical diplomacy.
In the past thirty-five years Cuba has tripled its number of health care workers. Even more striking is the change in the ratio of doctors to population. This went from one doctor for every 1,393 people in 1970 to one doctor for every 159 people in 2005. This was part of Fidel?s 1984 family doctor plan to put a doctor on every block. Having accomplished this in both urban and rural areas, even isolated ones, Cuba is now exporting this model through its medical diplomacy initiatives.
Cuba?s accomplishments in health realms are not just in primary care or in the production of doctors. There was a simultaneous development of high tech medicine and biotechnology as well. Cuba shares its expertise through numerous international medical conferences that it holds every year and through scientific exchanges. Because research is also an important part of the operation of the health system, in the medical and public health field alone, Cuba publishes fifty-four professional journals.
As early as 1982, the US government recognized Cuba?s success in the health sphere in a report that affirmed that the Cuban health system was superior to those of other developing countries and rivaled that of many developed countries. Despite economic hardship during the 1990s after the dissolution of the Soviet Union and the subsequent loss of its preferential economic relations along with the tightening of the then three- decade-old US embargo, Cuba continuously increased its spending on domestic health as a percentage of total government spending in order to shield the most vulnerable population from the worst effects of the crisis. As a result, the initial deterioration in the population?s health status was short-lived and the health indicators quickly improved. Today, even some US analysts who oppose Fidel Castro agree that Cuba?s health system has produced impressive results despite the many material shortages that it always has faced. Some critics also recognize, albeit reluctantly that Cuban medical diplomacy is producing positive effects in the recipient countries.
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