A study by scientists from the Antwerp Institute of Tropical Medicine, published online in the scientific journal Tropical medicine and International Health, shows that it is still possible to provide a good level of public health if one is prepared to reinforce the public health care system. The authors state that this applies even in times of severe crisis when the Gross National Product collapses, saying: “Look for instance to Cuba in the nineties.”

The worldwide crisis that started in 2008, along with its economic and social consequences means that hard-hit countries, such as Portugal and Greece, are desperately searching for options to cut down on expenditures. With steep economies in social security and healthcare underway, medical circles immediately warn that public health must not be endangered.

Studies from the epidemiology group of the Institute of Tropical Medicine on the previous crisis during the 90s, demonstrate that there are alternatives. Many developing countries were hit by a deep economic crisis in the 90s, the first decade of globalization. The Gross National Product took a slump of 42% in Russia, 38% in Cuba, 30% in Peru, 22% in Argentina and 14% in Indonesia, which led to vast unemployment, loss of purchasing power, etc.

The poorest and most vulnerable groups are hit particularly hard when social expenditure and health care is cut back. For instance, the adult mortality rate in Russia increased by 30% between 1990 and 1994, for reasons of social instability, dismantlement of the public health care, depression, malnourishment and alcohol. Another example is the devaluation of the Indonesian rupee by 80% in January 1998, which meant that private healthcare suddenly became unaffordable and over-burdened the public health care system, whilst Argentina and Peru experienced a sharp rise in child mortality.

Pol de Vos and his team’s research refer to Cuba, a country that followed a different path, after the Soviet Union, Cuba’s largest customer and investor collapsed in 1989, and the U.S. tightening its embargo shortly afterwards. It meant a sudden loss of 80% in imports and exports, with the Gross National Product dropping by 38.5 %, and despite food shortages, Cuba was able to largely maintain the population’s health and wellbeing in the face of the crisis, refusing to accept the IMFs instructions and holding on to social redistribution.

Interestingly, despite the crisis, several health indicators even continued to improve, such as child mortality and life expectation. Research shows a strong association between the rise in public health expenditure and the decrease in child mortality and rise in life expectation, whereas the number of children with low birth weight saw a temporary increase, although by 2000 the numbers were also lower than in 1989. Tuberculosis incidents also increased, peaking in 1995. Both were connected to the food shortage.

In spite of the general expectations that the decline in Gross National Product would lead to a dramatic drop in Cuban health, the government continued to hold on to assuring the basic needs of the population, by broadly discussing economic and social measures at the workplaces and in the districts and only implementing those measures that received broad public support.

The analysis reveals that due to these crucial, overall encouraging measures, Cuba achieved to also strengthen its public healthcare, particularly the first line making health services a priority at no cost, with the number of family doctors tripling and doctors focusing on prevention.

De Vos points out that even though Belgium or Greece cannot be directly compared to Cuba, given that each country has its own unique health system, it does no harm to learn from examples.

Written by Petra Rattue