Since the revolution Cuba has developed a remarkable and successful health care system unmatched in the third world. In developing a social policy that provides health care for all its citizens while at the same time organizing a pharmaceutical and biotechnology industry that is as resourceful as it is inspiring Cuba has made advances in medicine admired throughout the world. As The Economist maintained in 1996 "Cuban medicine is disciplined and innovative.... Cuban research establishments have made breakthroughs in vaccines, immunology and biotechnology."(1) The sophisticated nature of the medical establishment is evident as one travels the island visiting medical facilities, as I did in a series of visits between 1995 and 1997. The progress made by Cuba, particularly while under the constant harassment of the U.S. embargo, is really quite staggering and it is the purpose of this discussion to expand upon Cuba's medical program within the context of the embargo.
Labeling Cuba a threat to U.S. national security has provided Washington with the rationale to include medicine and basic food within the framework of the embargo making it "abundantly clear that economic sanctions are, at their core, a war against public health."(2) Indeed, because the embargo prohibits products that contain any U.S. component or material from being exported to Cuba from third countries, including products based on U.S. design and technology, and because most major new drugs are developed by U.S. pharmaceutical companies, Cuba has access to only a small percentage of the new medicines available on the world market.(3) The embargo as it affects medicine, scientific technology, textbooks and periodicals is a virtual world-wide blockade vigorously enforced by the United States. The minutia of enforcement, according to the New England Journal of Medicine, "are all-encompassing. The interdicted trade includes visits by medical delegations and the mailing of medical journals...."(4)
Because of the embargo the Cuban health care system exists within a frame of political and social contradiction. It is one of the jewels of the revolution, yet it is handicapped by the fierceness of the embargo and the fury of U.S. enforcement. While developing innovative medicines, and techniques for delivery of services, the Ministry of Public Health and hospitals must literally shop around the world paying exorbitant rates to obtain supplies, often secretly, that are, quite simply, available but unaccessible ninety miles away. In 1991 then U.N. Ambassador Ricardo Alarcon argued that the "U.S. embargo has caused Cuba substantial material losses. Total prohibition of Cuba's acquisition of foodstuffs, medicine and medical supplies and equipment of United States origin ... has caused and still causes appreciable additional harm to the Cuban people."(5) This remains the case today.
A major issue of importance then is to analyze the structure of the Cuban health care system, and to indicate its extraordinary accomplishments while examining what the United States is doing to try to destroy Cuba's public health organization. This will clarify the political impediments Cuba must deal with to continue providing a public health care program that is closely integrated with the development of medicines through biotechnology and the more traditional pharmacology.
Technology and Comprehensive Health Care
A country with merely 11 million people, Cuba has become a powerhouse of medical innovation. In this small country there are 284 hospitals, 440 clinics, 11 research institutes, and 15 medical colleges, while with some 60,000 doctors and more than 5000 researchers the "national average ratio of physicians to total population is one doctor for every 180 people, and this does not count ... nurses, physical therapists, medical technicians and medical researchers."(6) All physicians must complete a nine year medical program with formidable medical standards and an additional three years of study for specialization. …