Health is a universal human right, which should be safeguarded by government responsibility and included in all social policies. Only as such it is possible to ensure effective responses to the health needs of an entire population. The Cuban Constitution recognizes the right to health, and the country’s single, free, universal public health system and high-level political commitment promote intersectorality as a strategy to address health problems. Intersectorality is reflected in national regulations that encourage participation by all social sectors in health promotion/disease prevention/treatment/rehabilitation policies and programs. The strategy has increased the response capacity of Cuba’s health system to face challenges in the national and international socioeconomic context and has helped improve the country’s main health indicators. New challenges (sociocultural, economic and environmental), due to their effects on the population’s health, well-being and quality of life, now require improved intersectoral coordination in the primary health care framework to sustain achievements made thus far.

KEYWORDS Universal coverage, public health, health policy, social planning, intersectoral collaboration, Cuba

The Adelaide Statement on Health in All Policies (2010), lays out equity-based principles designed to guide policymakers on incorporating health and well-being components into the development, implementation and evaluation of policy and practice while moving towards shared governance at all levels—local, regional, national and international. Special emphasis is placed on cross-sector coordination to achieve policy goals, while improving health and well-being for all.[1]

In Cuba’s case, experience in disaster preparedness, particularly for hurricanes, has shown good cross-sector coordination.[2] Zika serves as another recent example. First identified in Uganda in 1947, Zika, an emerging disease with outbreaks in Africa, Asia, the Pacific and the Americas and linked to neurological disorders in newborns, was declared a global health emergency by WHO on February 1, 2016.[3] In response, Cuba further stepped up measures for surveillance, prevention and control it had already announced in December 2015. Building on decades of experience fighting dengue, intensified efforts to stamp out Aedes aegypti and albopictus, the mosquitoes that transmit Zika (as well as dengue, chikungunya and yellow fever), and issued a national 11-point Zika Action Plan to prevent, detect and respond to these arboviral infections.

Translated and reprinted with permission from RevistaCubana de SaludPública. 2016 Apr –Jun;42(2).
Original available from: http://www.revsaludpublica.sld.cu/index.php/spu/article/view/530

The current definition of universal health coverage lacks several elements essential to advance public health. This article aims to discuss the concept and interpretation of universal health coverage and suggests an inclusive definition that is applicable to states, governments, and the societal and economic sectors ultimately responsible for public health. We will discuss the complexity and social determinants of universal health coverage, and the need for health to be built through social action, together with the states, governments and all societal actors, within a supportive legal framework. One suggestion is to consider health coverage as the ability of society, states and governments to respond to population health and well-being, which includes legislation, infrastructure availability, social capital and technology, as well as comprehensive planning, organizational, action and financing strategies to protect the health of the whole population, equally and inclusively.

KEYWORDS Universal health coverage, public health, social action, Cuba

The global distribution of disease burden reveals alarming inequities that can only be tackled by generating the political will and organizational capacity for sustained intersectoral action (ISA) to address both health outcomes and the social determinants underlying population health indicators.

To bridge the gap often found between discourse and implementation, such action requires not only commitment and dedication of resources by leaders, central governments and the health sector itself but also empowerment of local communities—especially the poor and disenfranchised—to become a force for constructing health.