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Compulsory annual medical check-ups are yielding impressive results in Cuba.
In terms of having healthy people, the Cuban health service outperforms other low and medium income countries and in some cases, outperforms much richer ones too.
Despite spending a fraction of what the United States spends on healthcare (the World Bank reports Cuba spends $431 per head per year compared with $8,553 in the US) Cuba has a lower infant mortality rate than the US and a similar life expectancy. So how do they do it, and could other countries, rich and poor, learn from the Cuban example? World Health Organization director-general Margaret Chan certainly thinks so. She has praised the preventative nature of the Cuban health system and called on other countries to follow the Cuban example.
Healthcare in Cuba is free and universal, enshrined in the Cuban constitution as a fundamental human right, guaranteed by the state. And the foundation of their preventative health care model is at primary care level, the family doctors who oversee the health of those who live around the clinic. And Cuba does have lots of doctors.
Key to the prevention model is the annual health assessment, a full health check-up which every single one of their 1,287 patients will undergo, often at their homes. And there’s no getting out of it either. The data from this check-up allows the family doctor to put her patients into categories according their “risk”. If they’re healthy, the annual check-up is enough. But if they’re showing signs of ill-health, if they drink too much, smoke or have a continuing health condition, they’re seen much more regularly. It’s an integrated, whole-person approach to healthcare, perhaps too intrusive for some, but widely accepted within Cuba. The aim is to stop people getting ill in the first place.
According to Gail Read, executive editor of the international health journal, MEDICC Review, Cuba had to focus on prevention precisely because it is a poor country. "It’s much more cost-effective to treat hypertension by exercise than to do a coronary by-pass", she says. “It makes sense to go upstream, to catch the problem before it begins or very soon afterwards.“ So in this highly centralised country, data is gathered at the local level, fed up to the second tier of healthcare, the neighbourhood policlinic. Here, health trends are spotted and decisions taken about how best to intervene.
Cubans no longer die of infectious diseases because of a hugely successful vaccination programme, so people live longer. And an ageing population presents what one minister described as a “colossal challenge for the nation”.
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