To the Editors:
The Cuban public health and medical community was shocked to hear of the decision on the part of HINARI’s sponsors to suspend our access to this indispensable database of medical journals, apparently because Cuba has risen too high in the Human Development Index. Until then, we had received these full-text articles online through INFOMED, the health system’s network.
“Human development,” is much more than just “economic development.” To achieve high indicators in the former reflects a country’s political will and social investment to ensure equitable, inclusive access throughout society to the benefits of science, technology, health, education, culture, sports, social security and a peaceful environment. These are the factors that determine human development, even when economic resources are constrained, as long as they are used rationally. Thus our accomplishments in health have been cited—by some even as the “Cuban miracle”—because they have been achieved in a poor country blockaded for more than 50 years by the US government, but one that has given population health the highest priority, optimizing its scarce resources to that end.[1–4]
Access to the world’s best medical publications via HINARI undoubtedly has provided Cuban health professionals with new evidence and knowledge to improve patient care, as well as undergraduate and graduate teaching, research and service management at all levels of the public health system. I therefore join the ranks of those who are clamoring for this ill-advised decision to be reconsidered, in hopes that once again we will have access to such a valuable tool for our daily struggle to improve our people’s health.
Alfredo Espinosa Brito MD PhD (alfredo_espinosa@infomed.sld.cu)
Medical University of Cienfuegos, Cienfuegos, Cuba
The cost of obtaining such international literature without support from a program like HINARI is not proportionate to the ability to pay—either of the country, its citizens or its institutions. And that constitutes an inequity. It is within the spirit and commitment of organizations like the WHO, and a program like HINARI, to find a way to keep Cuba, its professionals and ultimately its people—actors and beneficiaries of health—from being excluded from an effort of such seriousness and palpable results.
- Spiegel J, Yassi A. Lessons from the margins of globalization: appreciating the Cuban health paradox J Public Health Policy 2002;25(1):85–110.
- Cooper RS, Kennelly JF, Ordunez-Garcia P. Health in Cuba. Int J Epidemiol. 2006;35:817–24.
- Evans RG. Thomas McKeown, Meet Fidel Castro: Physicians, Population Health and the Cuban Paradox. Healthcare Policy. 2008;3(4): 21–32.
- Campion EW, Morrissey S. A Different Model—Medical Care in Cuba. N Engl J Med. 2013;368;(4):297–9.
To the Editors:
I read with interest the article Poliomyelitis and its Elimination in Cuba: An Historical Overview by Dr Enrique Beldarraín in the April 2013 issue of MEDICC Review. There is a factual error on page 35, where the author states that the National Polio Reference Laboratory was transferred from the National Hygiene, Epidemiology and Microbiology Institute (INHEM) to the Pedro Kourí Tropical Medicine Institute (IPK) in the 1970s. In fact, this did not happen until 1989, when the Vice Minister in charge of hygiene and epidemiology at the time, Dr Héctor Terry, decided to transfer all INHEM’s communicable disease reference laboratories to the new facilities at IPK; this was part of a functional reorganization of related research institutes. As director of INHEM at the time, I was in charge of implementing these changes.
I hope the date will be corrected, for the sake of Cuban public health history
Pedro Más Bermejo MD PhD DrSc (pmasb@ipk.sld.cu)
Full Professor, Medical University of Havana
Senior Researcher, Pedro Kourí Tropical Medicine Institute, Havana, Cuba
The Author responds:
Professor Más Bermejo is perfectly right and I am grateful to him for pointing out the mistake, the result of a typographical error in my final version of the manuscript (it was meant to say the late 1980s). I apologize for the confusion and trust MEDICC Review’s readers will have access to the correct date.
Enrique Beldarraín Chaple MD PhD (ebch@infomed.sld.cu)
National Medical Sciences Information Center, Havana, Cuba
[See Erratum p. 40—Eds.]
