576652
research-article2015
TCNXXX10.1177/1043659615576652Journal of Transcultural NursingCuellar
Editorial
Cuban Embargo Restrictions Lifted: Impact on Health Care?
Journal of Transcultural Nursing 2015, Vol. 26(3) 217–218 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659615576652 tcn.sagepub.com
Norma G. Cuellar, PhD, RN, FAAN1
Over 50 years ago, the United States of America issued an embargo on Cuba for being a threat to the United States and other countries. This embargo, lasting longer than any other reported, consisted of economic sanctions and restrictions on Cuban travel and commerce. In 1993, the purpose of the embargo was modified by the Cuban Democracy Act, including concerns around human rights and democratic values. In early 2015, some of these sanctions were lifted, establishing new diplomatic relations between Cuba and the United States. Can these new relations affect the health care of the Cuban citizens, as well as neighboring countries? Identified as one of the poorest countries in the world, Cuba has been resilient in caring for their citizens. They are ranked #1 in public health and preventative primary care. The life expectancy for Cubans is 79.4 years (ranked at #38) compared with the United States at 79.8 years (ranked at #36). The infant mortality in Cuba is 4.76 deaths per 1,000 live births (ranked at #33) compared with the United States at 5.2% (ranked at #34). Cuba’s primary health care system is one of the most effective as evident by the cost of health care percentage of the gross domestic product (GDP) at 8.6% (ranked #104), while the United States has the highest GDP (ranked #1) at 17.9% (World Bank, 2015; World Health Organization, 2015). The Cuban health system bases its success on the use of polyclinics in communities in which the health care providers live in specific assigned communities to care for their patients. The aim of these clinics is based on population health with the goal to prevent disease and illness and work with the communities’ needs. Patients receive annual checkups in their homes and may receive more visits based on their health status. The polyclinics attend to 95% of the population in Cuba and offer a variety of services. Health care is free, and health care access is available to all (Cooper, Kennelly, & Ordunez-Garcia, 2006). There is twice the number of physicians per capita in Cuba than in the United States despite the fact that physicians are paid as low as $20.00 per month (with housing and food subsidies included). College education is free for medical/nursing school. Physicians are required to specialize in family medicine but can go back to school for another specialty (ie, cardiac). Health literacy is at 99% for the people of Cuba as a result of inclusion of health and nutrition education required in the school system (Campion & Morrissey, 2013; World Health Organization, 2008). There is a lack of technology available; Internet access is limited to the citizens and
students. Health care publications of articles from Cuba by US journals are not allowed (Campion & Morrissey, 2013). Due to the embargo, there has been less access to pharmacological agents that are available on the world market (ie, aspirin). Treatments for life-threatening diseases such as cancer and HIV/AIDS are not available mostly because these are made and developed in the United States. State-of-the-art treatment for many chronic health conditions is lacking. This may include treatment for renal failure (dialysis), computed tomography scans for diagnostic procedures, and so on. Food shortages result in a drop in food intake by most citizens, affecting health outcomes. In a similar incident, concerns of health care were an issue of citizens of Berlin with the fall of the Berlin Wall. The former countries that were Communistic went through substantial economic and social changes that had an impact on health care. Health care issues included concerns around selfreported health decreasing, concerns around aging citizens, infectious diseases, mental health issues, and concerns of health care due to changes in the embargo (Archberger, Linden, & Benkert, 1999; Ginter & Simko, 2010; Hillen, Schaub, Hiestermann, Kirschner, & Robra, 2000; Reintjes et al., 2002; Westerhof & Keyes, 2006). So, with the embargo restrictions decreasing, how will removal of some of the sanctions affect the health care of the people of Cuba? Will there be changes in immigration of Cubans into other countries, particularly, to the United States? Will health care in the United States and Cuba be affected by this change in the embargo? As health care providers interested in the care of all persons, globally, it is important for us to stay updated on this issue. The possibilities of influencing health care through collaborations with Cuban nurses through research, education, and scholarship will be essential during this time. References Archberger, M., Linden, M., & Benkert, O. (1999). Psychological distress and psychiatric disorders in primary health care patients in East and West Germany 1 year after the fall of the
1
University of Alabama, Capstone College of Nursing
Corresponding Author: Norma G. Cuellar. 650 University Blvd., Tuscaloosa, AL 35401. Email: [email protected]
218 Berlin Wall. Social Psychiatry and Psychiatric Epidemiology, 35, 195-201. Campion, E., & Morrissey, S. (2013). A different model—Medical care in Cuba. New England Journal of Medicine, 368, 297-299. Cooper, R., Kennelly, J., & Ordunez-Garcia, P. (2006). Health in Cuba. International Journal of Epidemiology, 35, 817-824. Ginter, E., & Simko, V. (2010). Health of Europeans twenty years after the fall of Berlin Wall. Bratislava Medical Journal, 111, 398-403. Hillen, T., Schaub, R., Hiestermann, A., Kirschner, W., & Robra, B. (2000). Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall. Journal of Epidemiology & Community Health, 54, 575-580. Reintjes, R., Nolte, E., Shamsul, B., Brand, H., Kramer, A., & McKee, M. (2001). Infectious diseases before and after German
Journal of Transcultural Nursing 26(3) unifications: Trends in mortality and morbidity. European Journal of Epidemiology, 17, 105-110. Westerhof, G., & Keyes, C. (2006). After the fall of the Berlin Wall: Perceptions and consequences of stability and change among middle-aged and older East and West Germans. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61, S240-S247. World Bank. (2015). Health expenditure, total (% of GDP). Retrieved from http://data.worldbank.org/indicator/SH.XPD. TOTL.ZS World Health Organization. (2008). Cuba’s primary health care revolution: 30 years on. Bulletin of the World Health Organization, 86, 325-346. Retrieved from http://www.who. int/bulletin/volumes/86/5/08-030508/en/ World Health Organization. (2015). Global Health Observatory (GHO) data. Retrieved from http://www.who.int/gho/en/
Copyright of Journal of Transcultural Nursing is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
research-article2015
TCNXXX10.1177/1043659615576652Journal of Transcultural NursingCuellar
Editorial
Cuban Embargo Restrictions Lifted: Impact on Health Care?
Journal of Transcultural Nursing 2015, Vol. 26(3) 217–218 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659615576652 tcn.sagepub.com
Norma G. Cuellar, PhD, RN, FAAN1
Over 50 years ago, the United States of America issued an embargo on Cuba for being a threat to the United States and other countries. This embargo, lasting longer than any other reported, consisted of economic sanctions and restrictions on Cuban travel and commerce. In 1993, the purpose of the embargo was modified by the Cuban Democracy Act, including concerns around human rights and democratic values. In early 2015, some of these sanctions were lifted, establishing new diplomatic relations between Cuba and the United States. Can these new relations affect the health care of the Cuban citizens, as well as neighboring countries? Identified as one of the poorest countries in the world, Cuba has been resilient in caring for their citizens. They are ranked #1 in public health and preventative primary care. The life expectancy for Cubans is 79.4 years (ranked at #38) compared with the United States at 79.8 years (ranked at #36). The infant mortality in Cuba is 4.76 deaths per 1,000 live births (ranked at #33) compared with the United States at 5.2% (ranked at #34). Cuba’s primary health care system is one of the most effective as evident by the cost of health care percentage of the gross domestic product (GDP) at 8.6% (ranked #104), while the United States has the highest GDP (ranked #1) at 17.9% (World Bank, 2015; World Health Organization, 2015). The Cuban health system bases its success on the use of polyclinics in communities in which the health care providers live in specific assigned communities to care for their patients. The aim of these clinics is based on population health with the goal to prevent disease and illness and work with the communities’ needs. Patients receive annual checkups in their homes and may receive more visits based on their health status. The polyclinics attend to 95% of the population in Cuba and offer a variety of services. Health care is free, and health care access is available to all (Cooper, Kennelly, & Ordunez-Garcia, 2006). There is twice the number of physicians per capita in Cuba than in the United States despite the fact that physicians are paid as low as $20.00 per month (with housing and food subsidies included). College education is free for medical/nursing school. Physicians are required to specialize in family medicine but can go back to school for another specialty (ie, cardiac). Health literacy is at 99% for the people of Cuba as a result of inclusion of health and nutrition education required in the school system (Campion & Morrissey, 2013; World Health Organization, 2008). There is a lack of technology available; Internet access is limited to the citizens and
students. Health care publications of articles from Cuba by US journals are not allowed (Campion & Morrissey, 2013). Due to the embargo, there has been less access to pharmacological agents that are available on the world market (ie, aspirin). Treatments for life-threatening diseases such as cancer and HIV/AIDS are not available mostly because these are made and developed in the United States. State-of-the-art treatment for many chronic health conditions is lacking. This may include treatment for renal failure (dialysis), computed tomography scans for diagnostic procedures, and so on. Food shortages result in a drop in food intake by most citizens, affecting health outcomes. In a similar incident, concerns of health care were an issue of citizens of Berlin with the fall of the Berlin Wall. The former countries that were Communistic went through substantial economic and social changes that had an impact on health care. Health care issues included concerns around selfreported health decreasing, concerns around aging citizens, infectious diseases, mental health issues, and concerns of health care due to changes in the embargo (Archberger, Linden, & Benkert, 1999; Ginter & Simko, 2010; Hillen, Schaub, Hiestermann, Kirschner, & Robra, 2000; Reintjes et al., 2002; Westerhof & Keyes, 2006). So, with the embargo restrictions decreasing, how will removal of some of the sanctions affect the health care of the people of Cuba? Will there be changes in immigration of Cubans into other countries, particularly, to the United States? Will health care in the United States and Cuba be affected by this change in the embargo? As health care providers interested in the care of all persons, globally, it is important for us to stay updated on this issue. The possibilities of influencing health care through collaborations with Cuban nurses through research, education, and scholarship will be essential during this time. References Archberger, M., Linden, M., & Benkert, O. (1999). Psychological distress and psychiatric disorders in primary health care patients in East and West Germany 1 year after the fall of the
1
University of Alabama, Capstone College of Nursing
Corresponding Author: Norma G. Cuellar. 650 University Blvd., Tuscaloosa, AL 35401. Email: [email protected]
218 Berlin Wall. Social Psychiatry and Psychiatric Epidemiology, 35, 195-201. Campion, E., & Morrissey, S. (2013). A different model—Medical care in Cuba. New England Journal of Medicine, 368, 297-299. Cooper, R., Kennelly, J., & Ordunez-Garcia, P. (2006). Health in Cuba. International Journal of Epidemiology, 35, 817-824. Ginter, E., & Simko, V. (2010). Health of Europeans twenty years after the fall of Berlin Wall. Bratislava Medical Journal, 111, 398-403. Hillen, T., Schaub, R., Hiestermann, A., Kirschner, W., & Robra, B. (2000). Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall. Journal of Epidemiology & Community Health, 54, 575-580. Reintjes, R., Nolte, E., Shamsul, B., Brand, H., Kramer, A., & McKee, M. (2001). Infectious diseases before and after German
Journal of Transcultural Nursing 26(3) unifications: Trends in mortality and morbidity. European Journal of Epidemiology, 17, 105-110. Westerhof, G., & Keyes, C. (2006). After the fall of the Berlin Wall: Perceptions and consequences of stability and change among middle-aged and older East and West Germans. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61, S240-S247. World Bank. (2015). Health expenditure, total (% of GDP). Retrieved from http://data.worldbank.org/indicator/SH.XPD. TOTL.ZS World Health Organization. (2008). Cuba’s primary health care revolution: 30 years on. Bulletin of the World Health Organization, 86, 325-346. Retrieved from http://www.who. int/bulletin/volumes/86/5/08-030508/en/ World Health Organization. (2015). Global Health Observatory (GHO) data. Retrieved from http://www.who.int/gho/en/
Copyright of Journal of Transcultural Nursing is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
