John Harris' film on Cuban health care can be seen on Newsnight on Tuesday
1 August 2006 at 2130GMT/2230BST on BBC Two in the UK and on the BBC
Newsnight website.
http://news.bbc.co.uk/1/hi/programmes/newsnight/4773911.stm
http://news.bbc.co.uk/1/hi/programmes/newsnight/5232628.stm
Keeping Cuba healthy
By John Harris
In the first part of Newsnight's world's best public services series, we
ask what Britain and the rest of the world can learn from Cuba's medical
system.
Young or old, patients get a home visit from their doctor once a year Last
week, when the crisis in Lebanon and the demands of Rupert Murdoch had yet
to grab all of his attention, Tony Blair gave a speech in Nottingham. His
subject was the worrying state of Britain's health, and its drain on our
national funds. Crudely put, the PM's message was that the NHS could simply
not afford the cost of treating people afflicted by obesity, alcohol abuse,
smoking and general bad living.
By way of an example, he cited diabetes: "Ten per cent of NHS resources
today are used to treat diabetes. By 2010 the estimate is that this could
double... and it's avoidable. Three quarters of diabetics are Type 2
diabetics, and two thirds of them have a disease which could be preventable
with exercise, diet and more healthy choices."
Five days later, Mr Blair arrived at Mr Murdoch's News Corp bunfight in
Pebble Beach, California. He told his audience that the age of tribal
politics was over, and when it came to policy ideas, left-right definitions
were increasingly useless.
So how about this: to really get to grips with his health worries,
shouldn't he have a look at the medical system in Fidel Castro's Cuba?
Cuban healthcare
256 hospitals
13 medical research centres
445 24-hour clinics
13,857 family doctors
Health care spending per person per annumn: Cuba $251; UK $2,389; US $5,711
Before anyone starts sending in irate emails, this is not intended as any
kind of endorsement of Cuba's wider political system or human rights
record. In any case, having an admiring look at the country's surgeries,
clinics and hospitals is hardly controversial: in 2001, members of the
House Of Commons Health Select Committee travelled there and issued a
report that paid tribute to "the success of the Cuban health care system",
based on its "strong emphasis on disease prevention" and "commitment to the
practice of medicine in a community".
The underlying logic of the Cuban system is amazingly simple. Thanks
chiefly to the American economic blockade, but partly also to the web of
strange rules and regulations that constrict Cuban life, the economy is in
a terrible mess: national income per head is miniscule, and resources are
amazingly tight.
Healthcare, however, is a top national priority, for reasons that draw on
the romantic (Che Guevara, the Communist Party's icon, was a doctor), but
have much more to do with pragmatism: the population's admirable health is
surely one of the key reasons why Castro is still in power.
The challenge, then, is to not so much treat illness as to stop people
getting sick in the first place.
Dr Ana Maria Fuentes is one of nearly 14,000 Cuban family doctors During
four days on the island, Newsnight examined how all this works in practice.
The first place we visited - in Jaruco, a small town about 30 minutes
outside Havana - was a Cuban doctor's surgery, or consultorio. Here,
patients are divided into five categories, from high-maintenance to
perfectly healthy, and the amount of attention they require is decided
accordingly.
But here's the crucial point: even if you've got a clean bill of health,
your local GP will still pay you a visit once a year. The idea is not just
to check on your physical health, but to have a look at your wider
lifestyle and home environment.
According to the doctor we met, there is also one particularly important
thing : your annual house-call will probably take you by surprise.
Policlinics
We also spent time at a Policlinic - an ingenious invention, aimed at
providing services like dentistry (around the clock!), minor surgery,
vasectomies and X-rays, without the need for a visit to a hospital.
We paid a visit to the Latin American Medical School, which trains would-be
doctors from all over the world - including, somewhat improbably, 71 from
the USA - the Cuban way.
And we came across the small social details that play their role in making
a big difference: platoons of pensioners exercising each morning in
Havana's parks, and the 120 club, a national organization for anyone who
fancies getting to 60 years old and thinking of it as life's half-way
point.
Comparisons
Cuba may be poor but it is not in poor health If you want quick proof of
how well all this works, consider Cuba's health indicators.
Its life expectancy and infant mortality rates are pretty much the same as
the USA's. Its doctor-to-patient ratios stand comparison to any country in
Western Europe.
Its annual total health spend per head, however, comes in at $251; just
over a tenth of the UK's.
Mr Blair's aforementioned speech, it should be noted, was partly aimed at
launching the government's latest bolt-on innovation to an NHS that seems
to be fragmenting at speed: surgeries located inside branches of Boots.
Will they fancy doing surprise house calls? Can they root themselves in
communities the way the Cuban consultorios do? Could they fit in with the
kind of organizational simplicity that seems to hold the key to Cuba's
success?
If left-right prejudices really are as redundant as the prime minister
reckons, his best-advised policy shift should be rather different.
Within reason - and though hell will freeze over, while pigs cruise over
Downing Street - he should go Cuban.
--------------------------------------------------------------------------------
John Harris' film on Cuban health care can be seen on Newsnight on Tuesday
1 August 2006 at 2130GMT/2230BST on BBC Two in the UK and on the BBC
Newsnight website.
-------------------
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