It was just before New Year’s Eve, 2019 when an emerging virus in China caught the attention of Dr Ileana Morales, director of Science and Technological Innovation in Cuba’s Ministry of Public Health. She had already participated in implementing Cuban protocols to prevent Ebola and address diseases such as Zika and dengue. But this was […]

The emerging SARS-CoV-2, a novel human coronavirus, caused the COVID-19 pandemic, with more than 9.5 million cases and 484 000 known fatalities to date (June 24th, 2020). In several regions, healthcare systems have collapsed whereas interventions applied to slow the viral spreading have had major social and economic impacts. After China, Europe, and the United States, Latin America has emerged as the new epicenter of the pandemic. By late-June, the region accounted for roughly 50% of global daily deaths (Gardner, 2020). The evolution of the COVID-19 pandemic in the region has been heterogenous as several countries are currently experiencing exponential growth of their daily cases and fatalities, while others have successfully controlled their corresponding outbreaks. Cuba confirmed its first COVID-19 cases in mid-March. After a three-month outbreak, the country recently began to move to a postepidemic phase. This dispatch details some relevant aspects of the strategy deployed in Cuba to face the COVID-19 pandemic and to decrease the impact of this emerging disease in the country. In addition, it describes the evolution of some epidemiological variables which allowed the country to de-escalate some of the non-pharmaceutical interventions applied during the outbreak. 

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

Cuba’s public health outcomes are rooted in political and social phenomena that have favored achievement of health indicators well above expectations for an economy of its size. A less studied causal component of Cuba’s development in health is the creation, from early in the 1960s, of scientific research capacity throughout the health system, including use of science to launch a domestic industry for manufacturing high-tech products. This component should play an even greater role in meeting Cuba’s 21st century health challenges, especially the demographic and epidemiological transitions, increasing prevalence of chronic diseases, rapid emergence of a complex-product biotechnology pharmacopoeia, greater molecular stratification of diseases, rising health costs, and the need to maintain communicable diseases under control in a global context of climate change and more population mobility.

Tackling these challenges will demand greater scientific influence in the health system, application of a scientific approach in all activities and at all levels, and integration with scientific endeavors of other sectors such as agriculture, industry and education.

KEYWORDS Public health, science, health care costs, health workforce, chronic disease, biotechnology, immunology, aging, Cuba

Public health systems face the contradiction of skyrocketing cancer incidence and cancer drug prices, thus limiting patient access to more effective treatments. The situation is particularly dire in low- and middle-income countries. We urgently need consensus on the main determinants of this problem, as well as specific, effective and feasible solutions.

Analysis of available data reveals that the problem has reached its current magnitude only recently and is not related to the growing complexity of drug production technology, but rather to corporate profits and the failure of market mechanisms to allocate resources based on health needs.

Despite the obstacles, there is ample room for effective intervention: joint price negotiations, cost transparency, greater support for creation of manufacturing capacity, and regulatory measures that facilitate introduction of generic and biosimilar drugs and reduce intellectual property barriers to better use of flexibilities in the Agreement on Trade-Related Aspects of Intellectual Property Rights.

Such actions will not be effective if there is no consensus around them, or if low- and middle-income countries act in isolation. This is precisely where international organizations must intervene.

KEYWORDS Public health, price, cancer drugs, inequality, less-developed countries, developing countries, Cuba

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

Excerpted by the author, translated and reprinted with permission from Revista Cubana de Salud Pública. 2015Jan–Mar;41(1):94–114. Original available from: http://scielo.sld.cu/scielo.php?pid=S0864-34662015000100009&script=sci_arttext

This paper discusses integration and implementation of population health and social determinants approaches to the health-disease–care process in the context of ongoing changes to Cuba’s health system. Ideas for strengthening the social conceptualization of public health and prioritizing population health actions over those of individual medical care are discussed, with a view to encouraging rethinking of these as social practice. The paper aims to advance new and renewed strategic proposals for change, based on a broad view of public health and a focus on social medicine that favors a population health perspective and inclusion of a wide range of health determinants. It advances the need to develop or extend debate on the theory and social practice of epidemiology and public health while implementing needed changes in health services and medical care. The paper recommends embarking on technical discussions among all actors and protagonists, not just in the health care system but in the entire health sector, to better integrate and practice a population health approach with social determinants of health.

INTRODUCTION To reach the goal of eliminating tuberculosis as a public health problem in Cuba, the epidemiological evolution of the disease and of strategies designed to prevent and manage it to date must be well understood. In this context, in 1970, changes were introduced in Cuba’s National Tuberculosis Control Program.

OBJECTIVE Review background and evolution of Cuba’s strategy for tuberculosis control, the changes implemented in the 1970 revision of the Program, and their impact on the subsequent evolution of the disease in Cuba.

METHODS Published articles on the history of tuberculosis control in Cuba were reviewed, along with archival documents and medical records. Documents concerning the situation of pulmonary tuberculosis in Cuba, including measures adopted to address the disease and its extent, were selected for study, with an emphasis on the period of the Program. Interviews with key informants were conducted.

RESULTS Cuba’s fight against tuberculosis began in Santiago de Cuba, with the creation of a local Anti-Tuberculosis League in 1890. Strategic changes introduced by Cuba’s public health sector, stressing health promotion and disease prevention, led to the 1959 creation of the Tuberculosis Department, which implemented Cuba’s first National Tuberculosis Control Program in 1963. This Program was completely reorganized in 1970. The National Tuberculosis Control Program (1963) covered a network of 27 tuberculosis dispensaries, 8 sanatoriums and 24 bacteriology laboratories. Diagnosis was based on radiographic imaging criteria. Incidence was 52.6/100,000 in 1964 and reached 31.2 in 1970. The Program was updated in 1970 to include two major changes: the requirement for bacteriological confirmation of diagnosis and directly-observed outpatient treatment fully integrated into health services. By 1971, incidence was down to 17.8/100,000, and further reduced to 11.6 in 1979. The decrease is interpreted as the result of the greater specificity of microbiologic diagnosis. Tuberculosis control continued to make progress, reaching an incidence rate of 6.1/100,000 in 2012 and mortality rate of 0.3/100,000 in 2013.

CONCLUSIONS Changes introduced in the National Tuberculosis Control Program in 1970 led to the successful results achieved in later decades, reducing tuberculosis incidence and mortality. These results also allowed health authorities to propose elimination of the disease in Cuba as a current objective.

KEYWORDS History of medicine, tuberculosis, epidemiology, communicable disease control, public health, Cuba

A review/analysis of current literature on exemplary multicenter registries of clinical dementias was conducted as a comparative basis for a proposed Cuban registry on cognitive impairment and dementia.

The study of mental health disorders has been predominantly based on clinical concepts and criteria, and only in recent years a public health approach has been applied. Traditional epidemiological studies do not reveal patterns of cognitive impairment and behavioral disorders (particularly dementias) in routine clinical practice in a defined geographic area, which would provide essential information for long-term planning and allocation of health and social resources. Thus, multicenter clinical registries have become an important source of clinical and epidemiological data on dementias in recent decades. This article addresses the Cuban proposal for an automated national dementia registry, comparing it to others internationally. The registry would be housed in the Neurology and Neurosurgery Institute, and would include a duly protected surveillance network hosted on the Institute’s website.

Such a multicenter dementia registry based on epidemiological surveillance methods and limited to a defined area would provide new, valid, representative and current data on dementia occurrence patterns by subtype, flow of case identification and referral from primary care, as well as the main clinical features of patients at the time of their first contact with health services. This information would support development of health planning policies for implementation of programs aimed at improved distribution of social and health resources in the affected population, monitoring of the disorder’s natural evolution and identification of preventive measures. The scientific benefits would be equally important: production of new knowledge, generation of hypotheses for clinical research projects, standardization of diagnostic criteria, and promotion of multicenter research in both national and multinational centers.

KEYWORDS Dementia, Alzheimer disease, cognitive impairment, disease registries, public health, surveillance, Cuba

This paper contextualizes the chronic kidney disease epidemic and related burden of disease affecting Central American farming communities. It summarizes the two main causal hypotheses (heat stress and agrochemicals), draws attention to the consequences of dichotomous reasoning concerning causality, and warns of potential conflicts of interest and their role in “manufacturing doubt.” It describes some methodological errors that compromise past study findings and cautions against delaying public health actions until a conclusive understanding is reached about the epidemic’s causes and underlying mechanisms. It makes the case for a comprehensive approach to the historical, social and epidemiological facts of the epidemic, for critically assessing existing studies and for enhanced rigor in new research.

KEYWORDS Epidemiology, public health, chronic kidney disease, causality, epidemic, agriculture, environment, agrochemicals, pesticides, heat stress, social determinants of health, Central America

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.