IFGH 2010: Public Health: Why are the Cubans so successful? A case study of public health governance in Cuba

Health outcomes are closely correlated with GDP. Cuba is the classic outlier in this regard. Expenditure on health per head of population in Ireland is $4,556, UK $3867 and in Cuba $585. Life expectancy in Cuba is 78years and 80years in Ireland and the infant mortality rates in Cuba and the UK are identical 5:1000 (WHO, 2010). The aims of this study were to examine public health governance in Cuba and to develop a model which explains the reasons behind the conspicuously good health outcomes.

A case study design was used which employed a variety of research methods: participant and non-participant observation; focus group and semi structured interviews. Twenty weeks of fieldwork, was carried out in Cuba.

Ten explanatory themes emerged from the findings: Ministry of Public Health; focus on prevention and health promotion; education; integration; primary care; citizenship; equity; public system; socialism and political will. The metaphor of a repaired umbrella is used as the basis for a theoretical model to explain Cuba’s success.

Cuba teaches the importance of health policy based on systematic needs assessment; strong political commitment to public health in Cuba and the pre-eminence of the Ministry of Public Health vis á vis other ministries.

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