Two countries that are examples of effective intervention of public health, Cuba and China, have recently initiated important policy changes, leaving some experts wondering if citizens will be worse off.
Cuba and the Obama administration started moving closer to normalized relations in September, which may uncover Cuba’s flaunted medical system to powerful new market pressures. China renounced its on-child policy in October, under which families were prohibited from having more than one child.
Both countries prize health care as a basic right.
Cuba is a well-known oddity; so poor that it can barely feed its citizens, yet able to beat or at least equal the United States in two important health indicators – child mortality and life expectancy.
Cuba has 500 local clinics and 30,000 family doctors, and every Cuban sees a doctor at least once every year. Bill Frist of Tennessee, doctor and former Senator, visited last year and applauded aspects of the primary care system in Cuba, stating that it harkens back to the days of house calls being made by family physicians armed only with their stethoscope and deep personal patient knowledge.
Thousands of Cuban doctors have been sent overseas on aid missions in the last decade. They have also treated 3.5 million patients. During the Ebola outbreak in West Africa last year, one American-built hospital was staffed by Cubans.
China has also made huge progress. As China became the globe’s factory town, the megacities planned to house millions of workers were built with sewer and water pipes, air conditioning, screened windows and nearby hospitals – amenities generally missing in the farm villages from which the workers came.
Clean water minimizes deaths from dysentery, cholera and more intestinal pathogens. Stopping flies and mosquitoes minimizes disability and deaths from yellow fever, malaria, leishmaniasis, trachoma and more.
Whenever epidemiologists discuss how much the world has improved in the last two decades, they generally have to add that most of that progress was in China.
Now Chinese researchers frequently publish work in top medical journals. China crushed its exploding SARS outbreak in 2003, and swiftly held off the swine flu pandemic in 2009 while scientists came up with a vaccine.
However, public health interventions in both Cuba and China have frequently had a coercive edge.
When Mao ordered a campaign to eliminate rural worm diseases, authorities blended deworming drugs into salt. Health teams and soldiers arrived in Chinese villages and ordered families to carry their salt to the public square, which was washed away with fire hoses and replaced.
To halt its SARS outbreak, China closed most large venues and every school in Beijing. To hinder the swine flu, it guided all foreign visitors with fever off planes into quarantine.
To suppress its AIDS epidemic, Cuba relied on harsh methods – and with great success.
HIV positive Cubans were forced to live in bungalow colonies until 1993. At mandatory checkups, even now, patients find it difficult to avoid tests for sexually transmitted diseases if the doctor believes they are warranted.
China holds nearly a fifth of the globe’s population. In place since 1980, the one-child policy prevented an estimated 400 million births. The policy also lowered child mortality.
Cuba protects children so well that its only improvement could be in neonatal intensive care.