“It was a remarkable five days,” said Carla Lewis, an APHA member who works as senior director for program development and evaluation at the Children’s Health Fund in New York. Her main interest was to meet medical teams serving communities in Havana.
“They’re basically situated in neighborhoods where they go into homes, and they scan the entire environment. So it’s a real comprehensive approach to health care,” Lewis said. “It’s really looking at the whole package, whether it’s nutrition or sanitation or mental health, everything from A to Z is in the mix.”
Patients are referred to polyclinics — or community-based clinics — equipped with medical specialists. The health care model is “a trilogy, so to speak, across service, education and research.” And unlike in the U.S., Cuba’s system does not seem to draw a line between medicine and public health but integrates the two.
Delegation members on the APHA trip learned that each family medical provider is assigned a set number of families with “everyone accounted for,” Lewis said. Research seems to be very needs- and community-based. The government pays for the medical education of students who agree to work in an underserved community upon graduation.
“The social responsibility, the human rights perspective, the inalienable right to health and education is so powerful,” Lewis said. “What we saw was a seamless relationship between the people and the public health system.”
According to the Pan American Health Organization, Cuba boasts a longer life expectancy and lower rates of infant and child mortality than the U.S. All obviously is not rosy, though, considering Cuban patients have no privacy rights, many facilities are old, and a decades-long trade embargo means essential drugs and medical technologies can be scarce on the island. Tight government control of the information that flows in and out of Cuba also meant delegation members likely saw only the positive aspects of the health system.
Yet the health system seems to offer many lessons in being community-driven and cross-disciplinary, such as bridging the links between such areas as transportation and health.
“We have much to learn, and I feel like on some level the embargo has undercut access to this wisdom,” said Lewis, who took from the trip a desire to “go global and expand our public health perspective.
“We should be looking at building models, public health models that work, and to look for openings where care starts to be a little more community driven and a little more environmentally savvy in terms of breaking some of the silos. I think a lot of our stuff is in silos here.”