Talk:Healthcare in Cuba

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Contents

[edit] Cite style

I would like to ask for heads up concering the referencing style employed by Ultramarine. Given the cite style of this page is clearly obvious from first appearance, and Ultramarine has been asked to reference material according to this citing style twice before, what would be the appropriate action to repeated material added using the wrong citation style? The simple reason being that there is no way this article can progress to good article status, as is my wish, with two competing citation styles. And I don't see why others should have to take the time to constantly reference this material, if he/she is simply ignoring requests.--Zleitzen 19:23, 19 October 2006 (UTC)

What policy are you referring to? Inline citations is an allowed citation style in Wikipedia.l Note that the article is extremely unstable due to the continued deletions of the sourced crtical material in the section Deleted critical material above. When the articles stabilizes, we can make the style uniform.Ultramarine 22:31, 19 October 2006 (UTC) [note: this material is now contained in Talk:Healthcare of Cuba/Archive 1 - Francis Tyers · 10:19, 20 October 2006 (UTC)]

See Wikipedia:Citing sources

If contributors differ as to the appropriate style of citation, they should defer to the article's main content contributors in deciding the most suitable format for the presentation of references. If no agreement can be reached, the citation style used should be that of the first major contributor

You note that the article has become unstable? The article was stable, will be stable again when you cease insisting that information agreed by numerous neutral verifiable academic sources is "pro-Castro". When you cease writing poorly worded material with no context. When you cease adding material that is repeated elsewhere. When you cease adding material that is sourced to POV groups who create that material for that purpose. When you cease adding material that is clearly misleading and misrepresents the source. Your constant claims of "continued deletions of the sourced crtical material" has been discussed at length and rejected by four editors above for obvious and well documented reasons. --Zleitzen 23:48, 19 October 2006 (UTC)

The first major contributor was Takethemud that created the article and added numerous sources. He used inline citations. As per Wikipedia policy, I am requesting that you change your citations to follow his style. Regarding the deleted sourced critical material, as anyone can see in the section above, no good explanations has been given for violating NPOV.Ultramarine 00:55, 20 October 2006 (UTC)
Fine, we can ask Takethemud for his/her thoughts. In the meantime, your request to change the detailed citation style developed on this page back to basic referencing has been added to your growing litany of disruptive/counter-productive actions. All will come out in the wash. --Zleitzen 05:11, 20 October 2006 (UTC)
Follow wikipedia policy as stated above.Ultramarine 10:20, 20 October 2006 (UTC)
Zleitzen asked for my thoughts about the citation style, so I figured I'd give them. I should preface this by saying that I didn't choose to use a particular citation style when I started this article - it was just the one I was more familiar with. With articles about Cuba, I have seen much debate take place over the most minute of topics in order to advocate on behalf of a "side." I hope that the citation style debate going on here is not in that vein and that it is taking place for other reasons. Personally, I prefer the end-note over the in-line style of citation; it seems more friendly toward non-internet sources and that is good since there have been cites to Hugh Thomas' and Richard Gott's books. I would cast my vote for the end-note style. But, if this is not acceptable to other editors, and a workable consensus can't be reached, then I think we should stick with wikipedia policy and keep it like it was when I started this article. takethemud 23:26, 21 October 2006 (UTC)takethemud

[edit] Deleted critical material

I have looked over the article and the talk page and can find no excuse for deleting this. The only explanation seems to be that some soruces, like the US state department, should be automatically excluded which of course violates NPOV (and they cite UN statistcs).. I would like detailed explanations for all deletions.

  • Miguel A. Faria Jr., M.D., describes the exportation of Cuban doctors to Third World countries as a "propaganda" exercise, stating that "it is easy because Cuba has an overabundance of physicians and professionals of all types, a perpetual oversight of the communist central planners".[1].
Crap source. Propaganda piece. We don't include stuff from "Socialist Victory" (or other fringe organisations), we don't need to include stuff from "Daily Reaction" (or whatever the guy writes for. Beware sources with an axe to grind! We don't need them, reliable sources are abound! - Francis Tyers ·
Actually, the doctor is quoting his published book, so I do not see what is the problem.Ultramarine 16:23, 16 October 2006 (UTC)
Get the book, get the quote. - Francis Tyers · 07:46, 17 October 2006 (UTC)
Huh? The exact title is mentioned in the article.Ultramarine 12:29, 17 October 2006 (UTC)
See above. - Francis Tyers · 12:47, 17 October 2006 (UTC)
Why can we include leftists like Richard Gott but not those critical? Ultramarine 16:15, 19 October 2006 (UTC)
  • The US State Department, citing many independent sources, states that Cuba's infant mortality rate in 1957 was the lowest in Latin America and the 13th lowest in the world, according to UN data. Cuba ranked ahead of France, Belgium, West Germany, Israel, Japan, Austria, Italy, and Spain, all of which would eventually pass Cuba in this indicator during the following decades. Cuba’s comparative world ranking has fallen from 13th to last out of the 25 countries examined. Also missing from the conventional analysis of Cuba's infant mortality rates is its very high abortion rate, which, because of selective termination of "high-risk" pregnancies, yields lower numbers for infant mortality. Cuba's abortion rate was the 3rd highest out of the 60 countries studied. In terms of physicians and dentists per capita, Cuba in 1957 ranked third in Latin America, behind only Uruguay and Argentina -- both of which were more advanced than the United States in this measure. Cuba's physicians and dentists in 1957 was the same as the Netherlands, and ahead of the United Kingdom and Finland. The report states "Unfortunately, the UN statistical yearbook no longer publishes these statistics, so more recent comparisons are not possible, but it is completely erroneous to characterize pre-Revolutionary Cuba as backward in terms of healthcare."[2] According to the same United States State department report, Pre-Castro Cuba ranked third in Latin America in per capita food consumption but ranked last out of the 11 countries analyzed in terms of percent of increase since 1957. Overall, Cuban per capita food consumption from 1954-1997 has decreased by 11.47 percent. Per capita consumption of cereals, tubers, and meat are today all below 1950's levels.[3]"
Is there any concrete argument against this, except that it is a US source which should be automatically be excluded? If this is the only arguments, then this violates NPOV.Ultramarine 17:29, 19 October 2006 (UTC)
  • Not all is free in the basic system. Patients must pay for drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs, crutches, and similar devices, as well as eyeglasses.[4] In 1997 A group of 18 Cuban doctors exiled in the United States released a statement denouncing the Cuban Government and specifically Fidel Castro. They claimed that in Cuba -"the medicines and equipment, even the bedsheets and blankets, (are) reserved for regime elites or dollar-bearing foreigners, to the detriment of our people, who must bring their own bedsheets, to say nothing of the availability of medicines."[1]
We can look at the UTexas link, but the CANF link is as above, probably rabid propaganda. Find other reliable sources to back up the claim and it is welcome in. Francis Tyers ·
If we can quote Granma, then we can quote CANF, obviously mentioning the source.Ultramarine 16:38, 16 October 2006 (UTC)
We shouldn't be quoting Granma apart from for "According to the Cuban government" information [e.g. "official" government figures]. Stuff that is "According to the CANF" is not useful. - Francis Tyers · 07:46, 17 October 2006 (UTC)
There is nothing more "rabid" about CANF than about official Cuban sources. Please, no double standard.Ultramarine 12:29, 17 October 2006 (UTC)
But they don't run a country. - Francis Tyers · 12:47, 17 October 2006 (UTC)
Why should those that run a country be considered more trustworthy? Using this argument, we should automatically include the US views above that you have deleted.Ultramarine 16:16, 19 October 2006 (UTC)
I wrote that piece "back in 1997 A group of 18 Cuban doctors..." and so on, I don't mind that staying in because it is an important point. Perhaps it could do with a better source. As a side note, the level of pressure on exiles to say these things is immense. Restrictions on freedom of speech and external pressures on Cuban exiles to say certain things to the Florida media, imposed by local leaders and politicians, has been investigated by human rights organisations. Cuba libre does not necessarily begin when people arrive in Miami, in some cases it gets worse, as Cuban Americans who have been beaten or had family members killed for not advocating the correct line will testify. 1997 was the high point of this pressure which has eased somewhat after the Elian Gonzales debacle.--Zleitzen 16:36, 16 October 2006 (UTC)
If you don't mind, go ahead. I've inserted the other part. - Francis Tyers · 10:17, 17 October 2006 (UTC)
  • The average life expectancy in Cuba has increased less than the average increase in Latin America. Ín Cuba is has increased 14.9 years, in South America as whole it has increased 16.4 years, and in the Caribbean and Central America it has increased 18.1 years. In Latin America infant mortality per 1,000 live births decreased by 76 between 1960 and 2004. In Cuba, it only decreased by 33.[5][6]
Original research. Francis Tyers ·
No, it is not. There is no original conlusion, only reporting of what the statistcs state.Ultramarine 16:28, 16 October 2006 (UTC)
  • The text seems to be deliberately misleading, stating "all U.S. subsidiary trade, including trade in food and medicines, being prohibited" and at the same time excluding and deleting Now up to thirty percent of the food Cuba imports comes from the United States.[2][3]"Ultramarine 12:33, 15 October 2006 (UTC)
  • According to the 2000 World Health Organisation report, as for all nations largely based on official government figures [7],
We've been through this a million times. It is already covered in the WHO article. Francis Tyers ·
I have never recieved any good answer. Obiviously statistics can be easily manipulated in an authoritarian state. We should point out that WHO statistcs are not necessarily accurate.Ultramarine 16:25, 16 October 2006 (UTC)
And like I said above, countless times, this is irrelevant for this article. Feel free to use the WHO article to discuss the reliability of WHO statistics. You could even mention something about statistics for authoritarian states in the article on the WHO! - Francis Tyers · 13:38, 17 October 2006 (UTC)
You think that WHO statistics are not necessarily accurate. Take it up with the WHO (again, a strongly worded letter might be in order). It isn't relevant here. - Francis Tyers · 10:17, 17 October 2006 (UTC)
Again, obiviously statistics can be easily manipulated in an authoritarian state. Do you admit that?Ultramarine 12:29, 17 October 2006 (UTC)
  • The fourth leading cause of death in Cuba is "external causes." That is, homicide, suicide and violent events. Cuba has four times the average rate of suicides compared to other countries with similar cultural backgrounds in the Caribbean region.[8]Ultramarine 16:02, 16 October 2006 (UTC)
Find more sources, like I did. It isn't hard. Francis Tyers ·
Again, there is no such requirement. Do you want me to demand that all the pro-Castro figures should have 3 sources? Ultramarine 16:26, 16 October 2006 (UTC)
Like I said above 2, feel free to add {{fact}} to any of the sourced material if you would like another reliable source backing it up. Hey wait, I said this before! - Francis Tyers · 07:46, 17 October 2006 (UTC)
Why should you be allowed to delete material you do not like, but I must insert a tag? Again, a double standard. Please explain why I cannot simply delete like you do.Ultramarine 12:29, 17 October 2006 (UTC)
Because I am acting in accordance with consensus. You aren't. You'll note that both myself and Zleity have added criticism to the article. You haven't added any non-criticism. A single-issue editor like yourself is always going to come accross resistance compared to more broad minded individuals. Again, I repeat, what do you dispute in the article, I will be happy to give more sources. - Francis Tyers · 12:47, 17 October 2006 (UTC)
Spare me the incivility and discuss the issues. From now on I will demand numerous sources like you do.Ultramarine 16:19, 19 October 2006 (UTC)
I'm being perfectly civil :) - Francis Tyers · 10:21, 20 October 2006 (UTC)
  • An article in Canadian newspaper National post, based interviews of Cubans, finds that in reality even the most common pharmaceutical items, such as Aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays.[9]Ultramarine 16:23, 19 October 2006 (UTC)
  • Castro himself admitted that while there was poverty, there was no economic crisis and no hunger in Cuba before the Revolution. [4]Ultramarine 18:01, 19 October 2006 (UTC)
  • Critics such as Juan A. Asensio, a trauma surgeon at the University of Miami and a Cuban American who has studied the island's medical system, questions whether the official statistics for things like life expectancy can be trusted.[10]

[edit] References

  1. ^ Defecting Cuban doctors blame Castro for Cuban Health Crisis Cubanet statement received and translated by the Cuban American National Foundation
  2. ^ http://globalization.about.com/od/bigstories/a/cubaembargo.htm
  3. ^ http://www.cbsnews.com/stories/2006/09/24/eveningnews/main2036729.shtml
  4. ^ (See Maurice Halperin: The Rise and Fall of Fidel Castro, University of California, 1972, pgs. 24, 25, 37)

The above is yet another of endless attempts to portray this dispute as one of "editors removing sourced material without excuse". The reasons given are many and have been addressed ad nauseaum in the archives. No amount of repeated pleading by Ultramarine is going to change this. He/She is welcome to proceed with a dispute process as I have requested he/she do 6 times now.--Zleitzen 10:36, 20 October 2006 (UTC)

As anyone can see, your "reasons" above are a not valid excuse for ignoring NPOV.Ultramarine 10:39, 20 October 2006 (UTC)
Well apparently people took a look, agreed with my reasoning - and thought any edits I have made to this article were valid, neutral and an improvement. Unfortunately your edits were deemed to be less valid by a number of people (to put it mildly) and were either removed or radically improved by others. There is nothing I can do about that I'm afraid. You are welcome to seek help from the dispute process. --Zleitzen 10:50, 20 October 2006 (UTC)
No good reasons has been given. Simply deleting criticisms while at the same having a double standard for pro-Castro statementgs are not acceptable. No, Wikipedia is not a survey or an opinion poll publishing the most common opinion. It is an encyclopedia based on verifiability and npov. That last stating that the views of all sides should be presendted.Ultramarine 11:19, 20 October 2006 (UTC)
You've said this again and again, without going into any detail about what these "views" actually contain. You've haven't argued for their validity in any reasonable or rational fashion that would encourage users to see your point of view. You merely repeat the same phrases about "violating POV" The fact is, as numerous people have pointed out, these views don't say anything new. They say the same things as is already in the article, but are worded in the terms of the biased pieces you have dug up. So althought the article already states "Cuba has had high indices since the 1950s" you write "It is completely erroneous to characterize pre-Revolutionary Cuba as backward in terms of healthcare. Cuba had high indices in the 1950s". So we then had 2 paragraphs essentially saying the same thing. One a neutral paragraph, one clearly a POV contortion as recognised by all but you. Your POV addition was rejected by consensus, I'm afraid. Perfectly within policy as we have explained on numerous occasions. Every editor has agreed with this analysis, both on this page and on the Cuba pgae where you tried to insert this info-bite some time ago.--Zleitzen 14:05, 20 October 2006 (UTC)
By the way, your repeated claims of "violating POV" and belief that the extensive outputs of the international medical community are merely "pro-Castro statements" hasn't aided your cause after weeks of repetition. Why do you think that this is going to change now?--Zleitzen 14:10, 20 October 2006 (UTC)
It is simply false to state these views are already in the article, as anyone who compares can see. Regarding the views of the US state department, your version has improved due to my editing but still does not mention the comparison to the improvements in other Latin American nations without a revolution, something certainly relevant and interesting when, as Cuba does, claiming that a better healthcare is a major benefit of the revolution. Regarding the views of the medical community, my sources cites UN statistics, dissident doctors, and medical organizations.Ultramarine 16:31, 20 October 2006 (UTC)
When and if they do cite them, they cite them in a "misleading and partisan way..." - Francis Tyers · 11:11, 21 October 2006 (UTC)
To Ultramarine's credit, the above paragraph does at least begin to address issues of content and relevance rather than being merely a protest against the "removal of sourced views". The problem here is that nowhere on this page do we carry the Cuban government's statements that "better healthcare is a major benefit of the revolution", we have one reference attributed to Hugh Thomas, Baron Thomas of Swynnerton (a right wing historian) to illustrate a point about pre-revolution healthcare but that is about as near as we get. We detail improvements and problems - hopefully in a serious way - taken from neutral sources, as any page would when dealing with a public service. The US state department piece is essentially arguing against political factors of its own design, that are not explored in the article and shouldn't be. It is a sledghammer applied to crack a nut, and the wrong nut in this case. That's before we go into the selective and unexplained parameters of the figures it provides. --Zleitzen 11:37, 21 October 2006 (UTC)
We have the views of Granma, Cuban official government statisitcs, http://www.cubasolidarity.net/, Che Guevara, and Richard Gott, who resigned due to KGB contaces. While excluding the views of Cuban dissident doctors, the view of the US to which 10% of the population has fled and is citing UN sources, medical organizations, and Castro himself.Ultramarine 13:43, 21 October 2006 (UTC)
The usual complete misrepresentation of what is on the page. No progress, Ultramarine, I'm afraid.--Zleitzen 15:03, 21 October 2006 (UTC)
Please give a good explanation.Ultramarine 15:07, 21 October 2006 (UTC)
Good explanations have been provided at length and ad nauseum many, many, many times in the archive. There are no "views" from the Cuban government on this page.--Zleitzen 16:34, 21 October 2006 (UTC)
If so, then add them above.Ultramarine 16:42, 21 October 2006 (UTC)

As an outsider, I think the facts of the article should be from non-partisan trusted sources (peer reviewed journals etc), per our policy. However, since we have the NPOV, we should give the extremist POVs (both ways, Cuba as heaven or Cuba as hell :-) some space, that's why I think that there should be a section on the dispute and the major claims of both groups. (a paragraph or so for each would be enough) bogdan 11:27, 21 October 2006 (UTC)

I don't agree with the dicotomy, I'm afraid. This isn't a "heaven and hell" situation of competing views. It is a case of how the same information is presented. Either neutrally, or with bias.--Zleitzen 11:48, 21 October 2006 (UTC)
That is of course what Wikipedia:NPOV says. all significant published points of view are to be presented, not just the most popular one. It should also not be asserted that the most popular view or some sort of intermediate view among the different views is the correct one. Readers are left to form their own opinions. Zleitzen is violating NPOV.Ultramarine 13:39, 21 October 2006 (UTC)
If all significant published points of view were presented, this page would be as long as the encyclopedia itself. Therefore there is need to present and select material carefully and neutrally in ensuring that all the issues are covered, avoiding repetition and/or misleading information from biased sources. I have yet to see evidence that your extreme point of view on this subject allows you to do that, Ultramarine. --Zleitzen 15:03, 21 October 2006 (UTC)
Now there is mostly pro-Castro views, excluding most of those critical and described in the section above. As the reader, can see most of the issues are excluded.Ultramarine 15:14, 21 October 2006 (UTC)
This page doesn't even mention Fidel Castro let alone carry "pro-Castro" views. Detailing reports by the WHO and all the other mainstream medical journals and outlets we have provided as sources are not "pro-Castro". You can repeat this wild claim again and again till the cows come up home, it won't make it any more true. --Zleitzen 16:34, 21 October 2006 (UTC)
Mostly pro-Castro statistics, while those negative are selectively removed.Ultramarine 16:41, 21 October 2006 (UTC)
Also, explain why the NPOV dispute template is removed? See Wikipedia:NPOV dispute: "In general, you should not remove the NPOV dispute tag merely because you personally feel the article complies with NPOV." Again, as per NPOV: Let the readers decide for themselves. Is there something dangerous with the readers even seeing this discussion? Ultramarine 15:20, 21 October 2006 (UTC)
Don't ask me, I haven't touched the POV label. There is nothing "dangerous" about your additions, they are just poorly worded/placed, redundant and written in an obviously and amusingly biased tone.--Zleitzen 16:35, 21 October 2006 (UTC)
But Francis Tyers do, here is his latest without any attempt of explaining why.[11]

[edit] Significant views

Above there are claims that this article is biased lacking most the views and issues, and calls to ensure that "all siginificant views are represented". Below are just a small amount of the significant views that have not been placed in this article. --Zleitzen 16:34, 21 October 2006 (UTC)

[edit] Views

Cuba's healthcare system, as with anything else to do with that country, is a minefield for anyone seeking reliable facts. However, one basic fact is now beyond dispute: Cuba has a first class health system achieved at a fraction of the cost associated with this level of success. A strong hint of the foundation for this success lies in the fact that Cuba has had a Ministry of Public Health since 1961. [12]

In 2006, BBC flagship news programme Newsnight featured Cuba's Healthcare system as part of a series identifying "the world's best public services". The report noted that "Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is miniscule, and resources are amazingly tight. Healthcare, however, is a top national priority" The report stated that life expectancy and infant mortality rates are pretty much the same as the USA's. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power.[1]

In 2000, Secretary General of the United Nations Kofi Annan stated that "Cuba should be the envy of many other nations" adding that achievements in social development are impressive given the size of its gross domestic product per capita. "Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities - health, education, and literacy." [2] The Kaiser Family Foundation, a non-governmental organization that evaluated Cuba’s health caresystem in 2000-1 described Cuba as "a shining example of the power of public health to transform the health of an entire country by acommitment to prevention and by careful management of its medical resources" [3] President of the World Bank James Wolfensohn also praised Cuba's healthcare system in 2001, saying that "Cuba has done a great job on education and health," at the annual meeting of the Bank and the International Monetary Fund. Wayne Smith, former head of the US Interests Section in Havana identified "the incredible dedication" of Cubans to healthcare, adding that "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated".[4]

In 2001, members of the UK House of Commons Health Select Committee travelled to Cuba and issued a report that paid tribute to "the success of the Cuban health care system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community".[1]

The Parliament of the United Kingdom also drew up an analysis of the key features of Cuba's healthcare system, drawing comparisons with the state funded National Health Service (NHS). The overall conclusion was that many of the features identified would not have occurred had there not been an obvious commitment to health provision demonstrated by the protection and proportion of the budget given the health care. The study concluded the following.

  • There appeared to be little evidence of a divide between the prevention/proactive response and the disease management/reactive response within Cuban healthcare.
  • By far the biggest difference was the ratio of doctors per person. In Cuba it was one doctor per 175 people, in the UK the figure was one doctor per 600 people.
  • There is a commitment in Cuba to the triple diagnosis (physical/psychological/social) at all levels.
  • Extensive involvement of "patient" and the public in decision making at all levels.
  • Integration of hospital/community/primary care via polyclincs.
  • Team-work that works is much more evident both in the community and the hospital sector and the mental-health and care of the elderly sites visited were very well staffed and supported. Select Committee on Health. </ref>

Cuban family doctors practice from individual consulting rooms but they are all attached to a neighbourhood polyclinic covering a population of about 30,000. The polyclinic provides many health and social services and is the base for nine specialists: three each in general medicine, paediatrics, and obstetrics and gynaecology. Increasingly, these specialists will have begun their careers as family doctors. In addition, consultants in many other specialties will visit the polyclinic on a weekly basis.

The emphasis is on dealing with problems in the community. If the family doctor can’t treat a problem, the patient will see a specialist in the polyclinic within two weeks. Sometimes the family doctor attends with the patient to learn from the specialist.

Many of the tests can be done in the polyclinic lab, and if the consultant feels an admission is required? With a surplus of doctors, and hospitals running at 70 per cent occupancy rates (down from 80 per cent in 1990 owing to fewer admissions), there generally won’t be much delay for admission or operation. The delays that do occur are usually the result of a shortage of spare parts for medical equipment that Cuba can’t easily obtain because of the US government’s economic blockade of the island.

A&E work is also handled somewhat differently. Every polyclinic provides a 24-hour emergency room staffed by family doctors on a rota, while selected polyclinics have in recent years been designated a wider role in emergency care (perhaps something akin to our minor injury units), with estate cars converted to basic ambulances. In 1980, hospitals handled 80 per cent of emergency consultations and polyclinics 20 per cent. By 1999, polyclinics were dealing with 55 per cent of cases, and the overall number of emergency consultations was 10 per cent below its 1985 peak. [13]

On such low wages Cuban health workers have to be dedicated to their work – and largely, they are. The emphasis in training is very much on being a servant of the people, and with private health care practice completely banned there is no conflict of interest for specialists. Though they might be dedicated, with far superior staffing levels they aren’t working under the degree of pressure experienced by many in the NHS. [14]

The Cuban medical system is the most efficient in this hemisphere. Everyone has a family doctor and Cuba still supplies young doctors to other countries for their rural health programs. These days Cuba is selling temporary interest in its beaches to international hotel companies so that it has enough money for national health care. [15]

The Cubans have a world class biomedical research and development facility [16]

Infant and under-five mortality rates are far below Third World countries and in some cases level with developed countries. [17]

Cuba is still more impressive on infant mortality, seen as the best test of a nation's healthcare. The US State Department puts death in the first year of life in Cuba at seven per 1,000 live births in 2000, slightly worse than Belgium, Israel and Italy (all six). [18]

Cuba emphasised prevention. This is more effective in a communist country because immunisation programmes, breast and cervical screening programmes and other health checks can be 100 per cent enforced. [19]

Patrick Pietroni, a dean of postgraduate general practice at London University, said: "What we can learn is how they have managed to produce these healthcare statistics which are sometimes better than ours at 1% of the expenditure. They have more family doctors, who are better trained than our GPs.

"When we went to Cuba what was so impressive were the three-storey buildings called consultorio. The ground floor was the practice, the first floor was the doctor's flat and the second floor was the nurse's flat. No Cuban lives more than 20 minutes or so from one of these." [20]

Some of the good health of the Cuban nation is, paradoxically, the product of adversity. Food is rationed and meat is scarce, so much of the diet is fruit and vegetables. Because there is relatively little public or private transport, most people walk or cycle everywhere. [21]

Immunisation is compulsory and thanks to the interest and investment the state is prepared to make in health, Cuba has a vaccine for meningitis B, which is now being investigated in the UK -although the prevalent strains in Cuba are not the same as here. [22]

While Cuba’s primary health care lacks equipment that British general practitioners take for granted and spends a fraction of the UK budget on health, it has health indicators equal to those of Europe. Cuban expenditure on health, as a percentage of gross domestic product, is higher than any country in the hemisphere except for Canada and 34% higher than the United States. Cuba’s health policy has been characterised as a dual policy of equity and priority for vulnerable groups. Despite tremendous scarcity, the country has managed to achieve envi-able health indicators through a focus onprimary health care. Perhaps necessity isthe mother of invention after all. [23]

By treating health care from a holistic perspective and implementing it as a constitutional right, Cuba has become a "powerhouse;" their health care a "jewel of the revolution" Cuba’s medical care system has been fiercely adhered to by its political leaders and citizens because of an ideology focused on human well being versus profits; it has been installed into the national value system and adhered to throughout its growths. Cuba’s health care system is revolutionary because rather than focusing on profit, it has made its focus the health of individuals, which capitalist countries have de-prioritized. Establishing their ideology as the basis, Cuba has formed their health care system into a free service, just one of the aspects in their socialist philosophy. Health is a constitutional right. In their Constitution, these basic four principles form the foundation of their philosophy. [24]

In 1985, during the American Public Health Association meeting, the Cuban Minister of Health was awarded the Edward Barsky Award for Cuba’s achievement of the WHO goal: "Health for All by the Year 2000" [25]

The Cuban strategy for an information society recognizes the critical importance of linkages among research activities and all economic sectors of activity, including health care. The accomplishment of this objective depends upon universal application of information technologies and development of national innovation systems and networks [24]. Extensive research has focused on the critical importance of proximate organization networks for knowledge creation and learning, particularly in health care and biotechnology [25-28]. This research has shown how diverse government, educational, research, and service entities contribute to effective research and development and service delivery [26]

The Cuban approach to health care could be characterized as “high tech-high touch,” integrating the family and community context in individual assessment and risk evaluation. Both the high concentration of health care professionals and the highly developed telecommunications and information systems of INFOMED contribute to this strategy. In the Cuban ideology, health care is viewed as a social process and a responsibility distributed throughout all levels of society. [27]

"In Cuba, there seems to be an even-handedness about how resources, admittedly limited, are allocated, and there is universal health care free of charge with an extensive nationwide delivery system. You don't find kids running around with unrepaired clefts or other basic deformities. Cuban healthcare is one of a doctor-patient relationship that is close - akin to the old family practitioner but occurring even with the specialists. There are shortages of materials, but there is a lot of compassion." [28]

During the 1990s, Cuba became the first country to develop and market a vaccine for meningitis B, and this sent export earnings soaring. Then there was a surge in exports of its hepatitis B vaccine, which is currently being shipped to 30 countries, including China, India, Russia, Pakistan and Latin American countries. [29]

In Cuba, health care is considered a human right for all citizens; health care is therefore a national priority. Cuba's health policy emphasizes prevention, primary care, services in the community, and the active participation of citizens. These emphases have produced an impressively high ranking on major health indicators, despite economic handicaps. The Cuban experience demonstrates the influence of ideological commitment and policy-making on the provision of health care and challenges the assumption that high-quality care for all citizens requires massive financial investment. [30]

Cuba's health system, which consists of a nationwide network of specialized medical centers and a human capital that exceeds 50,000 professionals, has designed a wide range of programs to improve the people's quality of life. The Caribbean Island provides alternatives to treat the most common diseases in the world, in addition to boosting rehabilitation, the fight against addictions and risk factors such as obesity.[31]

Regular medical checkups, which are available for foreign visitors, allow physicians to assess the patient's state of health and make it easier for them to give an accurate diagnosis of his/her ailments, which might be easily cured if detected in an early stage. [32]

Cuba's health system also provides specialized medical checkups to patients suffering from cardiovascular problems, hypertension, gynecological affections (in the case of women) and infertility, and to those who need plastic surgery, among other treatments.[33]

That way, Cuba offers state-of-the-art medical technology and highly-trained professionals, who are available to meet all medical needs and improve the people's quality of life. [34]

Cuba's outstanding achievements in health biotechnology are a source of inspiration for the developing world. They are all the more impressive considering that the island is a small, relatively poor country that has suffered serious economic difficulties for more than a decade. Cuban health biotechnology has reached its relatively advanced stage of development because of the vision of its political leaders and their continued commitment to promote the sector, despite difficult economic conditions, which might have slowed its development to the level it might have otherwise reached. Public research institutions form the backbone of the sector and often have commercial branches involved in manufacturing products. The tight integration, advanced development and close government control of the country's health system and biotechnology sector have all promoted the adoption of cost-effective treatment options and encourage collaboration between basic and clinical researchers. In addition, the highly educated population has a positive perception of the sector and readily participates in clinical trials, facilitating the development of new products.[35]

Public research institutions play a central role in Cuba's health biotechnology sector. They typically focus on relatively, well-defined fields, such as immunology, tropical medicine, immunoassays or vaccines. Most of them were established from the late 1980s to the mid-1990s. Some of the institutions are directly under the control of the Council of State, which allows close ties to the central decision-making powers of the country. Many of the institutions are concentrated in the western part of Havana and are a part of the West Havana Scientific Pole. The Pole is a cluster of research institutions, higher education institutions and hospitals that were linked in the early 1990s in an attempt to encourage closer integration of science, education and health.[36]

After the revolution, a central goal of the Cuban government was to improve the health of the population, and it established a health system with universal access. The health status of Cubans has improved substantially since 1959, and they enjoy a life expectancy of 76.7 years6, one of the longest in the Americas. The main driving force for the health biotechnology sector in Cuba has been to improve the health of Cubans, and the meningitis vaccine is a good example. The government's funding of both the development of health biotechnology products and the country's health delivery system provides incentives to focus on cost-effective health approaches, such as vaccines. Although the health biotechnology sector is oriented mainly toward Cuban health needs, exports are rising. [37]

The U.S. has an average of 1,000 meningitis cases every year and more than 100 people die, but researchers in Cuba have developed a vaccine against the disease. Already sold in some countries, it may soon be available in the U.S.

Cuba represents an important alternative example where modest infrastructure investments combined with a well-developed public health strategy have generated health status measures comparable with those of industrialized countries. Areas of success include control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others. [38]

Cuba is setting up an "extra muros" emergency care system in which first line policlinics and their community based G.P networks play an important role. The present proposal aims at developing an evidence basis for this reform. While globally analysing processes and outcomes, the research will focus on assessing the effectiveness of the new emergency system in delivering quality care, evaluating its efficiency, investigating its acceptability and formulating procedures for its monitoring. These objectives will be attained with (1) a descriptive ambispective study design in 3 urban areas where the reform is being introduced since early 1997, that will permit to adjust its course and to set new targets, and (2) a prospective quasi-experiment in 2 semi-urban and 2 rural areas, where the changes in the health system will be introduced during the study period, that will permit to more unambiguously measure progress and attribute accomplishments. [39]

I see no problem with including more pro-Castro views. This is no excuse for violating NPOV, see the section Deleted critical material above.Ultramarine 16:37, 21 October 2006 (UTC)
The point is that it makes for bad reading. Like the text equivalent of being in a room with two people trying to out-shout each other. Better to present neutral information from reliable sources. - Francis Tyers · 20:00, 30 October 2006 (UTC)
That, as they say, is a no-brainer!Felix-felix 10:47, 31 October 2006 (UTC)
Wikipedia:NPOV: all significant published points of view are to be presented, not just the most popular one. It should also not be asserted that the most popular view or some sort of intermediate view among the different views is the correct one. Readers are left to form their own opinions. No good justification has been given for the deletion of opposing views, see the section Deleted Critical Material above.Ultramarine 20:20, 31 October 2006 (UTC)
Justification provided at length over two talk pages using multiple sources, applying policy and enacted for the benefit of the encyclopedia - this page - and for readers. Your additions were deemed to be deeply flawed and had no consensus. Please pursue dispute process if you have further issues.--Zleitzen 02:03, 1 November 2006 (UTC)

[edit] Creating a searchable entry for 'Operation Milagro'

What do you think about creating a page for OM such that either searching for 'Operation Milagro' or 'Operation Miracle' would lead to the same place. I think it would be a nice addition on its own, let me know what you think? Bmathew 06:39, 1 December 2006 (UTC)

Redirect page created. I live to serve.Felix-felix 10:08, 3 December 2006 (UTC)
Wow, thank you! I was considering creating a completely new entry for OM but this is great for right now! Do you think its overkill to redirect "Operation Miracle" to the same target as well? Bmathew 11:12, 3 December 2006 (UTC)
I just tried to redirect it to the section but it didn't seem to work.--Zleitzen 11:19, 3 December 2006 (UTC)
I thought that you couldn't redirect to sections, but I'm not very literate at the wikipedia syntax yet. Btw I should get those photos this week, zleitzen.Felix-felix 11:28, 3 December 2006 (UTC)

[edit] Latest additions

I have Removed these latest additions to talk for analysis.

*The health services of Cuba have been known to be plagued with under-the-table payments. As far back as the 1970's Cubans used gifts and tips in order to get health benefits. The harsh realities of the "período especial" in the 1990's aggravated the under-the-table payments. With the advent of the "dollar economy" Cubans used dollars obtained in their "bizne" or through the funds sent from their relatives outside of Cuba, mainly in the United States, to obtain medications and health services that would not be available to them otherwise. A formal separation of the egalitarian, socialist health service under communism and a fee-for service system has evolved in Cuba in the past 10 years. The system may be called a "health apartheid" reminiscent of the discriminatory practices of South Africa many years ago. It is widely known that the Castro regime in the past years has organized and operates separate health services for tourists and the "dollar areas" where Cubans are not allowed to be treated through their national health system.

--Zleitzen 18:06, 4 December 2006 (UTC)

(system very slow at the moment) - There are one or two points here that I believe can be added to the article. Others that are already detailed. However it needs to be attributed and neutralised because it comes from a non-neutral source.--Zleitzen 18:06, 4 December 2006 (UTC)
Done.--Zleitzen 18:17, 4 December 2006 (UTC)

Are you disputing that Cuba has a state-run health care monopoly? Or that there are no private physicians or clinics permitted? --Uncle Ed 18:39, 4 December 2006 (UTC)

There are no private physicians or clinics permitted - I'm sure it did say that in the lead but it seems to have been lost when another editor tried to take a razor to the article some time ago and shifted a whole load of marterial around. That indeed can return and I'll add it back - good spot. As for a "state-run health care monopoly". No. Its a universal national healthcare system - where no private physicians or clinics are permitted. I don't beleive monopoly is the correct terminology for public services, anymore than describing the Finnish Education system as a monopoly is appropriate. Most countries have a certain view of public services - to use terms like "monopoly" betrays a POV - and is immediately recognisable as being one from a rather large North American nation in particular. Some might like or understand it but generally Cubans are as proud of their health system as the Fins are of their education system.--Zleitzen 18:52, 4 December 2006 (UTC)

Okay, I guess this means that "monopoly" is a loaded term. I used it in the sense of "system which prevents others from doing what one can do", but that didn't work in this context. Let's avoid the term, unless using it in quotes - preferably in the context of criticism from a named source.

I'll see if I can find something like:

  • An analyst with the Libertarian Healthcare Thinktank of Peoria, called Cuba's national healthcare system a "state-run monopoly". ("No aspirin for the masses in proud island 'utopia'", by Han Doubt)

Maybe after lunch though, I gotta run. --Uncle Ed 18:59, 4 December 2006 (UTC)

Ed, I usually love your attitude but can you read the article before you start finding US attack pieces and adding them to the article? It may be the case that a point is already in the article. We went through this rigmerole with another editor who was - how shall we say this - an extreme advocate of a certain ideology throughout wikipedia. And the net benefit to the article was less than satisfactory. I don't really like to see a small Caribbean island's healthcare system being used merely as a political football to advocate a specific US anti-state funding ideology.--Zleitzen 19:09, 4 December 2006 (UTC)

[edit] Unexplained revert

Zleitzen, pleawe explain this revert: [40]. I had given explanations for all the edits. What policy are you refering to= Ultramarine 14:41, 30 December 2006 (UTC)

[edit] Reorganise

Ultramarine. Do not reorganise large amounts of material on this page again until you have discussed these issues on the talk page. This also applies to other Cuban pages. Given the history of your re-organisations, which many editors have found problematic on this and other pages throughout wikipedia, to do so without discussion is not acceptable. --Zleitzen 14:42, 30 December 2006 (UTC)

Zleitzen, pleawe explain this revert: [41]. I had given explanations for all the edits. What policy are you refering to? Please explain why the article should include old statistics, mention some medical journal in the intro, and why unfavorable statistics are hidden in the history section?Ultramarine 14:44, 30 December 2006 (UTC)
Also, Ad hominem is not a valid argument. Try factual arguments, please.Ultramarine 14:47, 30 December 2006 (UTC)
  1. Your explanations were insufficient.
  2. Your record, including an [arbitration] decision against you concerning your repeatedly moving vast amounts of material around in an edit war, the many editors throughout wikipedia that have found these activities by you problematic, means that you should be extra careful and discuss largescale edits to articles with which you are engaging in. Otherwise the edits can appear extremely disruptive.
  3. Discuss each edit first. Perhaps we agree on some things and can collaborate to present material in the most coherent fashion. This cannot be acheived by your methods.--Zleitzen 14:54, 30 December 2006 (UTC)
Again, ad hominem is uninteresting. Use factual arguments. First, why should old statistics be mentioned when there is more recent? Second, why should the medical journal be mentioned in the intro, it is not the most prominent part and should be in a section in the body? Third, why is statistics like the high abortion rate in the history section and not the health indices section? Ultramarine 15:05, 30 December 2006 (UTC)

I'm also opposed to unilateral re-organisation. Perhaps you could bring some suggestions here and we could discuss them before making controversial changes. - Francis Tyers · 15:16, 30 December 2006 (UTC)

I have made my suggestions above. Please discuss them. What is controversial with the 3 points? Ultramarine 15:17, 30 December 2006 (UTC)
You haven't made 3 points, those three points are Zleitzen's. - Francis Tyers · 15:42, 30 December 2006 (UTC)
Read again. But lets repeat them:
  1. First, why should old statistics regarding life expectancy be mentioned when there is more recent?
    Please present the "new" statistics here for perusal. - ft.
    It is already in the text, compare the old life expectancy statistics to the more recent 2004. See this: [42][43]
  2. Second, why should the medical journal be mentioned in the intro, it is not the most prominent part and should be in a section in the body?
    Created a new section "Medical research in Cuba" and put it in there. More appropriate I think, do you agree? - ft.
    Better.Ultramarine 16:15, 30 December 2006 (UTC)
  3. Third, why is statistics like the high abortion rate in the history section and not the health indices section?Ultramarine 15:44, 30 December 2006 (UTC)
    Because it is a historical point. - ft.
    The abortion rate is still high. Also relevent for discussing infant mortality.Ultramarine 16:14, 30 December 2006 (UTC)
    Why is the abortion rate relevant for child mortality?Felix-felix 10:46, 31 December 2006 (UTC)

Thankyou for the suggestions. - Francis Tyers · 16:06, 30 December 2006 (UTC)

Why are you deleting the disputed template when there is ongoing discussions.Ultramarine 16:14, 30 December 2006 (UTC)

[edit] Violations of NPOV: Removal of sourced critical views

  • See the material in the section "Deleted critical material" above. Ultramarine 17:56, 12 January 2007 (UTC)
  • The US State Department, citing many independent sources, states that Cuba's infant mortality rate in 1957 was the lowest in Latin America and the 13th lowest in the world, according to UN data. Cuba ranked ahead of France, Belgium, West Germany, Israel, Japan, Austria, Italy, and Spain, all of which would eventually pass Cuba in this indicator during the following decades. Cuba’s comparative world ranking has fallen from 13th to last out of the 25 countries examined. Also missing from the conventional analysis of Cuba's infant mortality rates is its very high abortion rate, which, because of selective termination of "high-risk" pregnancies, yields lower numbers for infant mortality. Cuba's abortion rate was the 3rd highest out of the 60 countries studied. In terms of physicians and dentists per capita, Cuba in 1957 ranked third in Latin America, behind only Uruguay and Argentina -- both of which were more advanced than the United States in this measure. Cuba's physicians and dentists in 1957 was the same as the Netherlands, and ahead of the United Kingdom and Finland. The report states "Unfortunately, the UN statistical yearbook no longer publishes these statistics, so more recent comparisons are not possible, but it is completely erroneous to characterize pre-Revolutionary Cuba as backward in terms of healthcare." According to the same United States State department report, Pre-Castro Cuba ranked third in Latin America in per capita food consumption but ranked last out of the 11 countries analyzed in terms of percent of increase since 1957. Overall, Cuban per capita food consumption from 1954-1997 has decreased by 11.47 percent. Per capita consumption of cereals, tubers, and meat are today all below 1950's levels.[44]"Ultramarine 09:11, 12 January 2007 (UTC)
Have the last 6 months discussion, where explainations have been made many times that the material is already in the article - presented neutrally and not compiled from a report from a nation that declares Cuba to be an "enemy" - completely slipped your mind? By the way, nothing was removed. I merely restored the acres of material from other countries. I recommend you start from the beginning, asking yourself "What is the purpose of this site?". Is it (A) to present material in a clear and consise manner for readers or (B) to merely list a heap of random views repeatedly until the page is largely incoherent? --Zleitzen 09:19, 12 January 2007 (UTC)
Again, 10 percent of the population has fled the to US, so the US certainly has the right to an opinon. Also, NPOV requires the inclusion of all views, also from those critical. The article does not include these comparison regarding infant mortality, physicians, or nutrition, but only selectively good statistics.Ultramarine 09:27, 12 January 2007 (UTC)
Agreeing with Ultramarine, the fact that the US is an "enemy" of Cuba does not prove that its statistics are inaccurate. On the other hand, it may be that because US statistics on Cuban healthcare are accurate, the West as a whole tends to condemn Cuba's state monopoly on health care. --Uncle Ed 17:14, 12 January 2007 (UTC)
  • On the the other hand, critics note the Castro brough in foreign doctors and medical equipement when he himself become ill. During the 1996 Atlanta Olympics, elite Cuban athletes showed the highest use of the Olympic system's free health clinics. Medics reported that Cuban athletes' long-neglected health needs went as far as a lack of even simple dentistry. In a 2003 report, the NIH's American Journal of Public Health found that 33% of all Cuban refugee children have intestinal parasites, 21% have lead poisoning and all have higher-than-normal levels of disease.[45]Ultramarine 17:51, 12 January 2007 (UTC)
Francis Tyers first removed this without any explanations and then removed this again claiming that Zleitzsen has made comments, which he has not. Please explain.Ultramarine 17:51, 12 January 2007 (UTC)
Last time I checked, it was a violation of Wikipedia policy to remove properly sourced, relevant info from an article. Claiming that it's necessary to do so for NPOV reasons is absurd. This might have to go to Wikipedia:Dispute resolution. --Uncle Ed 20:27, 12 January 2007 (UTC)
I don't think this is properly sourced. Investors' Business Daily is not an authoritative or reliable source for evaluating health care, according to the Wikipedia proposed guidelines on medicine. In addition, the anonymous writer mistakenly identifies AJPH as an NIH publication, which it is not (so he doesn't pay too much attention to accuracy). In addition, the writer doesn't give citations for the articles he's referring to, so it's impossible to check back and see if he's quoting them accurately. I'd like to see criticisms of the Cuban health system, but I'd like to get them from knowledgeable sources, preferably medical journals, or at least interviews with doctors who have been to Cuba. In every reliable article I've seen about Cuban health care, when they get to the part about problems and failings, the problems are caused by the U.S. embargo. Do you have a reliable source for criticism? Nbauman 23:01, 2 February 2007 (UTC)
You have some points. By the same critera, much of the pro-Cuban material should be removed from the article. See also added point below.Ultramarine 23:59, 3 February 2007 (UTC)
If you are saying that we should apply the same standards to pro- and anti-Cuban material, I agree.
I believe that statements and evaluations of the Cuban health care system should preferably come from peer-reviewed journals, or at least from doctors who have been to Cuba. I'm willing to accept statements and evaluations of non-medical issues from reliable news sources like the New York Times, Wall Street Journal, etc. I don't think that editorial from the Investors Business Daily is a reliable source, because it's anonymous, inaccurate and third-hand or worse, basically a blog. He's cherry-picking studies that he doesn't understand. If somebody wanted to track back the original sources of that editorial, I would accept that.
I don't mind opinion from advocates -- the same as you would find in a newspaper -- as long as we have both sides, and they're informed advocates. White House statements about Cuba have unfortunately been factually inaccurate (like the one about Castro promoting child prostitution). I have a strong bias against people who get their facts wrong, on the right or left. But if you post their claims, and the rebuttals, I can accept that.
Does anybody object to that?
(I don't know what you mean by the "added point below".) Nbauman 02:50, 4 February 2007 (UTC)
This[46] is a critical but at least objective and first-hand account of the Cuban health care system, unlike the IBD story. Nbauman 22:45, 4 February 2007 (UTC)
  • Not all is free in the basic system. Patients must pay for drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs, crutches, and similar devices, as well as eyeglasses.[47] In 1997 A group of 18 Cuban doctors exiled in the United States released a statement denouncing the Cuban Government and specifically Fidel Castro. They claimed that in Cuba -"the medicines and equipment, even the bedsheets and blankets, (are) reserved for regime elites or dollar-bearing foreigners, to the detriment of our people, who must bring their own bedsheets, to say nothing of the availability of medicines."Defecting Cuban doctors blame Castro for Cuban Health Crisis Cubanet statement received and translated by the Cuban American National Foundation
  • The average life expectancy in Cuba has increased less than the average increase in Latin America. Ín Cuba is has increased 14.9 years, in South America as whole it has increased 16.4 years, and in the Caribbean and Central America it has increased 18.1 years. In Latin America infant mortality per 1,000 live births decreased by 76 between 1960 and 2004. In Cuba, it only decreased by 33.[48][49]
  • An article in Canadian newspaper National post, based interviews of Cubans, finds that in reality even the most common pharmaceutical items, such as Aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays.[50]
  • Castro himself admitted that while there was poverty, there was no economic crisis and no hunger in Cuba before the Revolution. (See Maurice Halperin: The Rise and Fall of Fidel Castro, University of California, 1972, pgs. 24, 25, 37)
  • Critics such as Juan A. Asensio, a trauma surgeon at the University of Miami and a Cuban American who has studied the island's medical system, questions whether the official statistics for things like life expectancy can be trusted.[51]
  • Miguel A. Faria Jr., M.D., describes the exportation of Cuban doctors to Third World countries as a "propaganda" exercise, stating that "it is easy because Cuba has an overabundance of physicians and professionals of all types, a perpetual oversight of the communist central planners".[52].
  • The fourth leading cause of death in Cuba is "external causes." That is, homicide, suicide and violent events. Cuba has four times the average rate of suicides compared to other countries with similar cultural backgrounds in the Caribbean region.[53]

[edit] Quality of health care

Proponents of communism (or more generally of socialism) like to brag about Cuba's "excellent" health care system, but when Castro needed top care recently he imported an expert from Spain.

  • A renowned Spanish surgeon has been flown to Cuba to try to stop a steady deterioration in President Fidel Castro's health, a Spanish newspaper reported Sunday. The surgeon, José Luis García Sabrido, an intestinal specialist, traveled to Cuba on Thursday on an aircraft chartered by the Cuban government, said the left-leaning newspaper, El Periódico de Catalunya. [54]

The fact that Cuba sends doctors to third world countries is sometimes used as an argument supporting "excellence" in Cuba, but sending even a medical school dropout to a country with no health care system would be of immense help there. It's no evidence that socialism or dictatorship promotes good general medical care better than free markets or democracy.

I'd like Wikipedia to describe neutrally two things:

  • the precise level of medical care Cubans enjoy (or suffer under), broken down by social class: top officials, Communist party members, general populace
  • arguments for and against socialized medicine

Perhaps the latter is beyond the scope of teh current article. --Uncle Ed 17:10, 12 January 2007 (UTC)

The latter (more accurately subsidised healthcare) is certainly outside the scope of this article. Regarding the "top officials" etc, is there any country where state bureaucrats and politicians in power don't get better care than the general populus? The points you raise are minor and are already covered in the article. Regarding, "... no evidence that socialism ...", Wikipedia is not a soapbox. - Francis Tyers · 17:46, 12 January 2007 (UTC)
Re Ed's second paragraph - the Cuban socialist system is much better than "free markets or democracy" because it actually sends its medical personal to impoverished countries whereas the free market countries don't ! -- Beardo 17:32, 13 January 2007 (UTC)
Western nations give a lot of foreign aid to developing nation. Cuba is very well paid for the doctors they send to Venezuela.Ultramarine 19:22, 13 January 2007 (UTC)

Thanks for trimming away the fat in my 12 January comment. Now, can we focus on the meat?

  • the most common pharmaceutical items, such as Aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays.

I'd like to see more about stuff like this, especially in view of the oft-repeated claim that Cuba's healthcare system is good/excellent. How does it fare, in comparison with the rest of the poor countries of the Caribbean basin - or for that matter, with Latin American countries generally? --Uncle Ed 00:18, 4 February 2007 (UTC)

The quality of Cuban health care can be divided into 2 questions: (1) How good is the Cuban health care system objectively, in terms of standard outcomes like infant mortality, life expectancy, etc. (2) How good a job are the Cubans doing managing their health care system given their resources and restraints, particularly the U.S. embargo? Does socialized healthcare work? That's the subtext behind the facts we post to this article.
This story from the National Post (an openly anti-socialist newspaper) says that the shortage of common pharmaceuticals is the result of Cuban policies, not the embargo. I don't know how she can come to that conclusion. If there were no embargo, American charities would certainly send medical supplies to Cuba.
Aspirin is such a cheap, cost-efficient way to prevent cardiovascular disease that it's shocking if it's not available at a reasonable price in Cuba. If there were no embargo, I'd send them $100 worth of aspirin. (I wouldn't say that about tetracycline and cortisone; they have serious adverse effects.) I agree it belongs in the entry, but I'd like to confirm it. I'd feel more ready to believe it if I heard it from somewhere else besides one conservative newspaper columnist. And I'd like to know why it's so difficult for them to get aspirin, which is manufactured everywhere. Cuba has a good pharmaceutical industry -- they've been manufacturing interferon for years. Rather than a laundry list of all the products that aren't available, I'd be more interested in knowing why aspirin isn't available. Is there a discussion of this anywhere in all the sources that are linked from this entry? Nbauman 22:24, 4 February 2007 (UTC)
Your own intersting source states the same thing: [55]. As for reason, probably the same reason that there was rationing of meat and sugar and the average family had to live for 10 years in a 8x8 feet room in the Soviet Union in 1989. Corruption, failed planning, and general inefficiency in state monopolies. Someone will get a lot of foreign currency for selling interferon to foreigners. So why produce aspirin? I am sure that the 5-year plan includes aspirin, and that someone states that this has been produced, but this is false and covered by a minor bribe, or the aspirin got diverted after production and sold abroad, or all the aspirin is stored in a warehouse since someone forgot the make plans for distribution, or all the aspirin got shipped to only one district, or whatever. It is only the common people who are interested in the aspirin really reaching them and in a dictatorship they are uninteresting and without a voice.Ultramarine 10:04, 5 February 2007 (UTC)
Rationing in Cuba was introduced in March 1962. The embargo - which affected up to 80% of the economy - was fully implemented in February 1962. Typical sources in the United States tend to skirt around or obscure this rather obvious chronological consequence. That's understandable - and is comparable to the Chinese attitudes to the traumas it has inflicted on neighbouring Taiwan or Nepal, or the historical colonialists attitudes to its errant satellites.
You'd do better examining the workings of the Cuban economy in relation to Britain in 1948 - examining the nationwide rationing which lasted 16 years, the vast nationalisation programs, the creation of universal healthcare etc. Britain could implement all these things on one island without interference or a barrage of adverse propaganda because it remained a powerful colonial state. Likewise, the central planning and universal healthcare measures of Scandinavia. Weaker post-colonial societies such as Cuba were not afforded this autonomy and it had to be stamped out by powerful external forces with vested financial interests.
These days, one can find numerous critics of central planning and Universal Healthcare in Europe, here Stephen Pollard writes "The private sector has shown how to improve education and health".[56] This is all very interesting, until one realises that Stephen Pollard is paid by drugs companies like Big Pharma and Pfizer etc to write these articles. This is a fairly classical example of how perceptions are distorted by vested minority interests, and has pertinence here.
I'm no communist, nor statist, but such cynical manipulation in the service of minority profits is certainly more transparent and lucid than theories about "asprins getting shipped to the wrong district". Likewise, one needn't be to Friedrich Engels to conclude that if an embargo on 80% of trade is implemented in February, and rationing implemented in March, the two are somehow related? It would seem to take some effort to wilfully put aside such obvious considerations.--Zleitzen 15:36, 5 February 2007 (UTC)
I am not sure how the scandinavian universal healthcare is related to their nonexistant colonies and its pharmaceuticals and medical equipment are produced by private companies. As Nbauman notes, aspirin is a simply medicine to make so Cuba has only itself to blame for shortages.Ultramarine 15:52, 5 February 2007 (UTC)
Please read History of Scandinavia for some basic background on that subject - colonial history etc. Meaning that a country such as Sweden, which had a number of historical colonies in the Caribbean trading tobacco for example, is historically a strong nation and therefore exploitation from the outside is unlikely. Cuba, which endured a history of genocide, slavery and gross exploitation is on the other side of the divide. As for importing pharmaceuticals and medical equipment from the private sector, all universal healthcare systems import from Big Pharma including the UK's NHS. Where is the pharmaceutical industry primarily based? The United States.--Zleitzen 16:33, 5 February 2007 (UTC)
Sweden had no colonies when creating its welfare state in the 20th century. Aspirin is not patented anymore so any pharmaceutical industry with any competence can make it. Furthermore, it can be bought cheaply from other nations as a generic drug and even if there is a 30% addition to costs from shipping, it is still very cheap. Only incompetence or worse can explain its absence in Cuba. Ultramarine 16:38, 5 February 2007 (UTC)
It's an interesting theory that aspirin in Cuba is not available because of incompetence or worse. I'd like to see facts to support that. There are many other alternative explanations.
  • It could be that the accounts we're reading, which all seem to be opposed to Castro, are exaggerating the situation.
  • It could be that the manufacture of aspirin requires some equipment which is not available because of the boycott.
  • It could be that the embargo restrictions on international shipping and on foreign subsidiaries of U.S.corporations are so disruptive that they make it prohibitively expensive to ship aspirin to Cuba. (The Wall Street Journal sent a reporter to the Iraqi border during the U.N. embargo, to talk to importers, and he found out that it was impossible to ship commercial quantities of innocent products like batteries for children's toys.)
  • Finally it could indeed be that the Cuban government is incompetent and can't manage to manufacture or import a cheap, important drug even though it's widely available around the world.
Which one is it? People who believe in certain political ideologies won't need any evidence to accept one of those explanations, but for the rest of us, what are the facts? Somebody must have done a serious study of this. Nbauman 17:38, 5 February 2007 (UTC)
Here is an article that best explains the issues surrounding pharmaceuticals, and the lack of financial resources needed to purchase the necessary raw materials [57]. If we don't differentiate between a historically strong imperial nation like Sweden - which was able to create a welfare state with impunity - and a historically weak, colonised Caribbean nation, then there isn't much more I can say to help. Blaming the miserable poverty that exists throughout Latin America and the Caribbean, which thankfully is historically far less acute in Cuba than many areas elsewhere, on "incompetence or worse" is a narrow view. Perhaps a trip to Jamaica, Guatemala or Honduras would be in order to discover whether the poor conditions there were as a result of "incompetence or worse" on the part of the local governments? Jamaica is of particular interest, because it too suffered the collapse of the Caribbean sugar export economy in the late 20th century, due to the rapid growth of the Indian and Brazilian markets. All the larger Caribbean nation are sliding into an economic abyss only sustained by international aid and tourism, and have been for 25 years. There are numerous factors which need to be considered when analysing the status of Cuba over the past 50 years. And most have nothing to do with "Communism". --Zleitzen 17:16, 5 February 2007 (UTC)
Again, since Sweden had lost its coloines many years before creating its welfare state, they are irrelevant. On the other hand, Cuba had one of the best healthcare systems and best health indicators in the Wesern hemisphere at the time of the revolution. Regarding Central Amercia and the Caribbean, their infant mortality and life expectancy is very good and has increased faster than Cuba.Ultramarine 17:30, 5 February 2007 (UTC)
Here is the data for life expectancy for the region: [58] Several nations now have longer than Cuba and all have seen marked increases.Ultramarine 17:36, 5 February 2007 (UTC)
Right. I'll let you carry on believing that infant mortality and life expectancy is very good in Central America and the Caribbean. That Sweden's strength and ability to create a welfare state had nothing to do with it's historical position etc. As for the rest - we've been through this many times before and it's all explained on the archive page. Cuba's life expectancy grew from 62 to 77 (approx). The regional average from 54 to 72. Are these figure evidence of the failures of Cuba's healthcare system? When Cuba's life expectancy was 62, the life expectancy in the US - which controlled up to 80% of the Cuban economy - was 70 and it is now (approx) 77-8. Therefore overall Caribbeans and Central Americans have lived approximately 8-10% shorter lives than Americans. Given the historical political dominance of the US (and Europeans who live even longer) over the region, do you think that situation is "very good" as you describe it? . I hoped to have some kind of valid discussion on the background to this article. I'll give that dream up again.--Zleitzen 17:53, 5 February 2007 (UTC)
I do not believe anything, I cite WHO statistics. If the US is responsible for everything in the region and these nations are completely dependent, then the US should be very proud of the remarkable increase in life expectancy of 18 years.Ultramarine 17:58, 5 February 2007 (UTC)
That article from IPS is a good answer to my question. The Cubans say that the embargo is indeed responsible for the absence in the pharmacies of ordinary drugs like aspirin, because they have to import even raw materials from China. Combined with the broader economic effects of the embargo, even aspirin is expensive by local standards. Anyone who has a medical need for those drugs gets a medical certificate. Would you agree, Ultramarine, that this is the Cuban government's response? Nbauman 17:38, 5 February 2007 (UTC)
Obviously the Cuban government will blame every problem imaginable in Cuba on the embargo. This still does not explain the absence of aspirin, a very cheaply made drug that can easily be imported. No, there is no need to import raw material from China for it, it can be bought from almost any country with a pharmaceutical industy, like in Europe or Latin America.Ultramarine 17:45, 5 February 2007 (UTC)
I've never bought a railroad car full of aspirin from overseas (and I doubt that you have either), so I don't know how it's done. How do you know that Cuba can buy aspirin from Europe or Latin America? The U.S. embargo prohibits U.S. companies, their subsidiaries, their affiliates, and ships that stop at U.S. ports from dealing with Cuba. That might exclude most of Latin America and Europe. Does this have any effect on the availability of aspirin? It would take tens of millions of dollars in hard currency to supply aspirin to a country of 11 million people. Do the Cubans have that money? How much aspirin are they getting already? Maybe the Cubans can't get aspirin because they're incompetent managers, or maybe there's another reason. When you say the reason is socialist incompetence, you're saying that because you assume a socialist government will be incompetent, not because of facts that confirm that assumption, right? Nbauman 01:04, 6 February 2007 (UTC)
You not describing the current situation correctly. The US is the largest source of foreign food for Cuba today so obviously there are contacts now. Even Cuba claims no more than a 30% higher costs due to additional transports. Socialist failure regarding central planning is a well documented fact. In the Soviet Union, stores could for example one day have an abundance of hats and at the same time no shoes due to mismanagement. Obviously people will buy then buý anything they can and does not really need because there will soon be a shortage, creating more problems. Factories could never depend on getting necessary goods like tools or machines due to poor planning and miscalculations by the central planners; therefore factories prefered to produce everything themselves if possible, creating enormous inefficiens.Ultramarine 02:56, 6 February 2007 (UTC)
So you're saying that socialist central planning was a failure in the Soviet Union, so therefore it must have been a failure in Cuba, and that's why they can't buy aspirin. Do you have any facts to support that theory, or is it just an inference based on your understanding of socialism? Nbauman 05:13, 6 February 2007 (UTC)
None of us has any hard evidence for any explanation and the government explanation in a dictatorship is unreliable.Ultramarine 10:55, 6 February 2007 (UTC)

Here are some interesting sources suggesting that even those with chronic conditions do not get the Aspirin they need. The explanation suggested is that the non-dollar Cuban stocks have been shipped abroad.[59][60] Probably only corruption can expain this, that is beyond mere incompetence.Ultramarine 14:08, 6 February 2007 (UTC)

What level of evidence do you think is sufficient to include something in an entry? Do you think it's enough to have a suggestion about non-dollars stocks, and to say that something is probably due to corruption, or do you think it's necessary to have specific facts to support those conclusions, like we would find in a peer-reviewed scholarly journal? Nbauman 04:38, 7 February 2007 (UTC)
There will be difficutly finding any reliable general facts about Cuba since statistics or other government info from a dictatorship is unreliable.Ultramarine 17:08, 7 February 2007 (UTC)

[edit] Congratulations

Congratulations. We now have three paragraphs detailing 1950s Cuban healthcare in three different parts of the page. I think a general review of this page would now be : hopelessly incoherent as a result of ongoing sabotage.--Zleitzen 14:19, 13 January 2007 (UTC)

[edit] Cuban doctors

User:Felix-felix has removed the following without explanation, only stating that it is irrelevant: "Miguel A. Faria Jr., M.D., describes the exportation of Cuban doctors to Third World countries as a "propaganda" exercise, stating that "it is easy because Cuba has an overabundance of physicians and professionals of all types, a perpetual oversight of the communist central planners".[61] However, the countries receiving these doctors clearly do not suffer from this "overabundance."Ultramarine 07:07, 17 April 2007 (UTC)

How is the inclusion of this opinion quote by this non-notable person relevant?FelixFelix talk 22:17, 17 April 2007 (UTC)

[edit] Infant mortality

The article states that Cuba has the lowest infant mortality rate in the Americas besides Canada. America usually appears high on ratings of infant mortality, I believe because it includes stillbirths in the count while most other countries do not. Does Cuba include stillbirths in its infant mortality rate or is this known?--Gloriamarie 22:17, 25 June 2007 (UTC)