Cuba's health care policy: prevention and active community participation

Soc Work. 1990 Jan;35(1):29-35.


In Cuba, health care is considered a human right for all citizens; health care is therefore a national priority. Cuba's health policy emphasizes prevention, primary care, services in the community, and the active participation of citizens. These emphases have produced an impressively high ranking on major health indicators, despite economic handicaps. The Cuban experience demonstrates the influence of ideological commitment and policy-making on the provision of health care and challenges the assumption that high-quality care for all citizens requires massive financial investment. The evolution of the Cuban health care system since the revolution thus has implications for the U.S. health care system; specifically, it suggests that the equitable distribution of health care services in the United States requires a national health insurance and service delivery system.

PIP: The new Cuban government in 1959 began overhauling the for-profit health system which, 30 years later, resulted in free health services for all its citizens which is integrated with national social and economic development. Life expectancy in Cuba is higher than that of the US (72.5 vs. 71.9). Health workers have eliminated polio, tuberculosis, typhoid fever, and diphtheria. Malnutrition incidence amount 1-15 years olds is 0.7% compared with 5% in the US. The Cuban health system began in the 1960s as a curative system based in hospitals but shifted during the 1970s and 1980s to a primary health care system based in communities. It consists of 6 hierarchical, interlocking levels: national health institutes and hospital centers (quaternary care-super specialty), provincial hospitals (tertiary care-high specialty), municipal hospitals (secondary care-specialty), area health centers (primary or community care) serving 25,000-30,000 people, sector polyclinics serving 4000-5000 people, and minipolyclinics served by a family physician team (family physician, nurse, and social worker) covering 600-700 people. The family physician team strategy has strengthened disease surveillance and completed information about health status and characteristics of neighborhoods. Neighborhood residents determine their own health care and protection. In fact, volunteer brigades build minipolyclinics and housing for family physicians and nurses. Critics of the Cuban health care system claim that the physician-to-population ratio is too high and that it makes up too much of the gross national product (almost 15%). Yet even though the US health system is the largest industry in the US and it has achieved impressive technological advances, the health of millions of US citizens deteriorates. The US needs a system that provides just, equitable, and quality health care to all. Thus US social workers should actively work toward national health insurance and on service delivery models.

MeSH terms

  • Cuba
  • Delivery of Health Care / organization & administration*
  • Health Policy*
  • Health Services Accessibility*
  • Humans
  • Physicians, Family
  • United States