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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