Country Report: Cuba
The Republic of Cuba is an archipelago comprising the island of Cuba and more than 1,600 islands, islets, and keys covering an area of 109,884 km2. It is administratively divided into 15 provinces and 168 municipalities.
Between 1990 and 2015, the population increased by 7.6%, reaching 11, 23,004 in 2015. In 2010, the urban population was 8.6 million, and the rural population 2.6 million (76.9% of the population was urban).
In 1990, the population structure was expansive among people over 30, although in 2015, the under-30 population became regressive due to mortality and low fertility.
In 2015, life expectancy at birth was 78.4 years (80.4 years in women and 76.5 in men).
In 2015, Cuba obtained a high human development index, ranking 67th among the 188 countries of the world.
- The school health program is geared to health promotion and disease prevention. It provides health services through physicians and nurses to children under 5 in kindergartens and primary schools with enrollment of more than 600 students, boarding facilities, and special education schools.
- Risk factors, morbidity, and mortality have been reduced in the school-age population, and there is integrated, intersectoral, and interdisciplinary work with the community to promote healthy habits and behaviors.
- The country has 136 maternity homes, which are community referral centers for the care of pregnant women, created to prevent morbidity and mortality. They constitute an NHS success story in the effort to protect and continuously improve maternal and child health.
- Family doctors provide comprehensive care in homes and health care facilities with the support of multidisciplinary geriatric teams. New geriatric services have been implemented in the country, for a total of 36 with 769 beds in 2014.
Figure 1. Distribution of the population by age and sex, Cuba, 1990 and 2015
Mortalidad proporcional (% defunciones totales, todas las edades, ambos sexos), 2014
Source: Pan American Health Organization. PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Source: División de Población y División de Estadísticas de las Naciones Unidas 1990; Organización Panamericana de la Salud. Plataforma de Información de Salud (PLISA) 2013, 2014 y 2015.
SOCIAL DETERMINANTS OF HEALTH
- In 2014, 95.2% of the population had access to safe drinking water (98.1% urban and 85.4% rural), and 96.7% to basic sanitation (98.2% urban and 91.7% rural)
- In the 60-74 age group, 57% have completed secondary and university studies, with 11.1 mean years of schooling in 2015.
- In 2015 there was internal migration of 80,581 inhabitants (41,524 men and 39,057 women). Habana was the preferred destination. That same year, Cuba broke its record for foreign visitors, with 3,524,779 arrivals—a 17.4% increase over 2014, making tourism the country’s second largest source of revenue.
- The National Health Policy considers health an essential component of human well-being and a strategic development goal. Health services are differentiated to meet the needs of each territory, community, population group, family, and individual to guarantee equity and efficiency based on an assessment of the health situation at each level of the system.
- The greatest danger from climate change will continue to be rising sea levels, bringing coastal flooding, salinization of aquifers and soil, and the destruction of the natural and built coastal environment.
- Cuba is vulnerable to hurricanes. In 2012, Hurricane Sandy killed 11 people and injured more than 100, with serious flooding and material damage.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In 2015, the fertility rate was 45.1 live births per 1,000 women of reproductive age. The maternal mortality ratio was 41.6 deaths per 100,000 live births in 2015, primarily due to direct causes (24.8 deaths per 100,000 births), rather than indirect ones (16.8).
- The infant mortality rate has continued its steady decline, falling to 4.3 deaths per 1,000 live births in 2015. More than 80% of deaths were caused by disorders of the perinatal period, congenital malformations, influenza and pneumonia, accidents, and sepsis. The percentage of low birthweight was 5.3%.
- Infant mortality (children under 1 year) fell during the period 2010-2015, from 4.5 to 4.3 per 1,000 live births. More than 80% of deaths in this age group were due to perinatal disorders.
- Mortality in children under 5 remained at 5.7 per 1,000 live births. Specific mortality in the group aged 5-9 was 0.2 deaths per 1,000 population between 2010 and 2015, with accidents and malignant tumors the leading causes. Among adolescents aged 10-19, accidents were the leading cause of death.
- The National Immunization Program, which protects against 13 diseases, has achieved the eradication of polio, diphtheria, measles, whooping cough, rubella, mumps, neonatal tetanus, and TB meningitis in children under 1 year, congenital rubella syndrome, and post-mumps meningoencephalitis. Vaccination coverage remained above 98.7% in the period analyzed at all territorial levels.
- The incidence rate of meningococcal disease remained at 0.1 per 100,000 population.
- In 2014, circulatory system diseases caused 38% of deaths and neoplasms 25%. These two causes account for almost two thirds of all deaths in an aging population in which most deaths are among older adults.
- The total mortality rate in 2015 was 8.9 deaths per 1,000 population. Among the top 10 causes of death in 2015, heart disease ranked first, with a rate of 218.3 deaths per 100,000 population, almost tied with malignant tumors (215.0). The principal causes of death among people aged 20-59 are malignant tumors, heart disease, and accidents.
- The prevalence of hypertension in Cuba was 217.5 per 1,000 population in 2015, higher than the figure for 2010, which was 202.7.
- In 2015, 10.5% of children were overweight and 5.9% obese. Thanks to state subsidies for basic foods and coverage and support for vulnerable groups, less than 5% of the population was undernourished. In 2010, 43.8% of the population was overweight and 14.8% obese, with a higher prevalence of both among women (47.1% and 18.1%, respectively).
- In 2015, there were 1,623 confirmed cases of dengue. That same year, 40 cases of chikungunya were confirmed, as were incidents of cholera transmission, with 65 confirmed cases.
- An active search for fever cases, border surveillance, and environmental sanitation have been important factors in controlling dengue, chikungunya, Zika, and yellow fever, while control of the Aedes aegypti mosquito is the key element for interrupting transmission.
- In 2015, the reported malaria rate was 0.01 cases per 100,000 population, all of which were imported. Cuba maintains the standards for the elimination of this disease, as well as those for yellow fever.
- Leprosy had a prevalence of 0.2 cases per 10,000 in 2015. The tuberculosis incidence rate was a low 5.8 per 100,000 in 2015, and efforts are being made toward elimination. As of 2015, HIV prevalence in the population aged 15-19 was 0.27%.
- No cases of human rabies have been reported since 2009. In 2014, 175 cases of leptospirosis were reported, mainly in men working in the agricultural sector.
- Government investment in biotechnology has led to significant progress in the early diagnosis and timely treatment of cancer, thus increasing survival rates. In 2015, it was estimated that nearly 120,000 people suffered from this disease.
- In 2015, 11,104 traffic accidents were recorded, with 788 deaths and 8,185 people injured. The country has a Road Safety Plan whose objective is to reduce the death rate to 5 per 100,000 population within 15 years.
- The National Occupational Health Program includes pre-employment and periodic primary care exams. There is a secondary, more specialized level of care for the treatment of occupational diseases and work-related accidents. New groups of workers in the non-state sector exceeded 500,000 people in 2015.
- With respect to tobacco use, 40% of men and 20% of women reported some history of smoking. Prevalence is trending downwards, except among adolescents, where the rate remains unchanged.
- Alcohol consumption is higher in men (47%) than in women (19%). Among adolescents under 15, 11% of men report having consumed alcohol, as well as 3% of females.
- The development and consolidation of the National Health System (NHS), overseen by the Ministry of Public Health (MINSAP), has been a priority effort since 1959 and has received significant government attention and resources.
- The NHS is organized and operates according to the principles of universality, free health care, accessibility, regionalization, and comprehensiveness. The system is structured into three territorial levels (national, provincial, and municipal) and three levels of care. It has a network of integrated and comprehensive, general and specialized, decentralized and regionalized services ranging from primary to tertiary care, with a primary health care (PHC) approach.
- There is a Social Security System comprised of the Social Security and Social Welfare systems. The former ensures protection to all persons with disabilities and grants pensions, economic subsidies for maternity leave, and subsidies for illness or accidents.
- The latter offers care for the elderly and persons with disabilities through programs geared to improving their quality of life and integration into society.
- In 2015, the country had 11,958 medical units, 151 hospitals, and 12 research institutes constituting the highest level of specialization in the NHS. The total number of beds for medical care is 45,892, while there are 14,168 social welfare beds.
- Per capita health expenditure in 2015 was the equivalent of US$ 639.60, with a very low level of out-of-pocket health expenditure.
- The NHS made necessary changes in the period 2010-2015, intended to continue improving the health of the population, increase the quality of the serves and user satisfaction, and make the system more efficient and sustainable.
- In 2015, there were 495,609 health workers, 70.6% of whom were women. There were 7.84 physicians per 1,000 population, and universal coverage was achieved through the family physician and nurse model.
- In 2015, the country launched monitoring and evaluation strategies with the support of automation and digital literacy. Its use is an inescapable challenge for achieving more complete and sustainable social development. Infomed is the NHS telematics information network.
- The biotechnology industry manufactures 525 generic drugs and eight vaccines, which are also exported to generate foreign exchange to finance the NHS. Cuban medical services abroad are another major source of financing that contributes to the sustainability of the NHS.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- On 30 June 2015, Cuba was recognized by the World Health Organization as the first country in the world to obtain certification of the elimination of mother-to-child transmission of human immunodeficiency virus and congenital syphilis, following a rigorous review process and submission of a country report that documents all that was done to achieve and sustain this milestone.
- In 2015, Cuba achieved the Millennium Development Goals. The country also adheres to its decision to comply with international agreements on women’s rights and is working toward the achievement of gender equity.
- The country’s dynamics and demographic features receive priority attention. Among these is the low fertility of the population, aging, and the consequential loss of the replacement rate, with increases in chronic non communicable diseases.
- Chronic diseases not only entail high mortality but produce heavy burdens, including recurrent problems and growing disability; these conditions are putting growing demand on the health services. Therefore, more human, material, and financial resources must be allocated to meet health needs.
- It is important to improve the resiliency and response capacity of the health sector, given the relationship between climate change and human health. This calls for the development of important new interventions.
- A great challenge for the coming years is to adopt mechanisms that will ensure sustainability and consolidate the achievements within a new demographic, epidemiological, economic, social, and political context.
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